OBJECTIVE: To compare the clinical efficacy of herbal cake-separated moxibustion at Baliao acupoints combined with western medication versus western medication alone in treating erectile dysfunction (ED) with kidney deficiency and blood stasis. METHODS: A total of 108 ED patients were randomly divided into a combination group (54 cases, 2 cases dropped out) and a western medication group (54 cases, 1 case was eliminated, 2 cases dropped out). The western medication group received oral tadalafil tablets 5 mg a time, once daily. The combination group received additional herbal cake-separated moxibustion at Baliao acupoints (Shangliao [BL31], Ciliao [BL32], Zhongliao [BL33], Xialiao [BL34]) twice weekly (administered on Tuesdays and Fridays). Both groups were treated for 4 weeks. The 5-question international index of erectile function (IIEF-5) score, erectile hardness assessment (EHS) score, TCM syndrome score, serum sex hormone levels (follicle-stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], testosterone [T]), penile hemodynamic parameters [peak systolic velocity (PSV) of penile cavernosal artery, end-diastolic velocity (EDV), resistance index (RI)] were compared before and after treatment between the two groups, and the safety and clinical efficacy were evaluated. RESULTS: After treatment, the IIEF-5 scores, EHS scores, serum T levels, PSV and RI of penile cavernosal artery were increased compared with those before treatment in the two groups (P<0.05). Except for RI, the combination group exhibited significantly higher improvements in the above indexes than those in the western medication group (P<0.05). After treatment, the TCM syndrome scores, the serum FSH, LH levels, and EDV in the two groups and the serum PRL level in the combination group were decreased compared with those before treatment (P<0.05), while the above indexes in the combination group were lower than those in the western medication group (P<0.05). The total effective rate of the combination group was 88.5% (46/52), which was superior to 72.5% (37/51) in the western medication group (P<0.05). No significant adverse reactions occurred in either group. CONCLUSION Herbal cake-separated moxibustion at Baliao acupoints combined with western medicine can regulate sex hormone levels, improve penile blood supply, enhance erectile function and hardness, and is superior to western medication alone, with no observed adverse reactions.
Humans ; Male ; Moxibustion ; Erectile Dysfunction/drug therapy* ; Middle Aged ; Adult ; Acupuncture Points ; Drugs, Chinese Herbal/administration & dosage* ; Kidney/physiopathology* ; Aged ; Follicle Stimulating Hormone/blood* ; Luteinizing Hormone/blood* ; Treatment Outcome

This paper reports a case of a patient with sleep-related painful erections treated by acupuncture combined with abdominal vibration therapy. The main symptom was repeated painful penile erections during nighttime sleep. The syndrome was differentiated as "water failing to nourish wood" and "liver qi stagnation". Acupuncture was applied at Baihui (GV20), Sishencong (EX-HN1), Guanyuan (CV4), and bilateral Neiguan (PC6), Hegu (LI4), Taichong (LR3), Taixi (KI3), Guilai (ST29), Yongquan (KI1), Yanglingquan (GB34), and Sanyinjiao (SP6). The treatment was combined with abdominal vibration therapy. Treatment was given once daily, five times per week. After the first treatment, the severity and duration of nocturnal erection pain were reduced, and sleep quality was improved. After two weeks of treatment, nocturnal erection pain persisted but became tolerable, with significantly shortened duration.
Humans ; Male ; Acupuncture Points ; Acupuncture Therapy ; Erectile Dysfunction/physiopathology* ; Penile Erection ; Sleep

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) has been available in Singapore since 2016, its uptake among gay, bisexual and other men-who-have-sex-with-men (GBMSM) is low. The iPARTY study was established to evaluate the acceptability and feasibility of PrEP and a PrEP teleconsultation service for young GBMSM aged 18 to 29 years. METHOD: A total of 53 young GBMSM were enrolled in the iPARTY study. They had a total of 5 in-person consultations and teleconsultations, at 12-week intervals. Laboratory tests and quarterly baseline surveys were performed to assess PrEP adherence, sexual behaviour, and incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). RESULTS: Thirty-five participants completed the entire 12-month follow-up. Most participants had positive experiences with PrEP teleconsultations. There was a statistically significant fall in participants' aggregate Patient Health Questionnaire-9 scores throughout the study. Self-reported PrEP adherence decreased over the course of the study, denoting improved mental health. Although self-reported condom use for anal intercourse and participants' risk perception of HIV decreased after PrEP adoption, there was no statisti-cally significant increase in STI incidence. CONCLUSION This pilot project has shown that PrEP services provide an opportunity for YMSM to access sexual health testing, treatment and counselling, and may even have tangible benefits on the mental health of this population. Teleconsultation is shown to be a suitable platform for the delivery of such services. Collaborative initiatives are crucial to further enhance the affordability and accessibility of PrEP in Singapore, and to improve patient adherence.
Adolescent ; Adult ; Humans ; Male ; Young Adult ; Anti-HIV Agents/administration & dosage* ; Feasibility Studies ; Health Risk Behaviors ; HIV Infections/psychology* ; Incidence ; Medication Adherence ; Mental Health/statistics & numerical data* ; Pilot Projects ; Pre-Exposure Prophylaxis/statistics & numerical data* ; Sexual and Gender Minorities/statistics & numerical data* ; Sexually Transmitted Diseases/prevention & control* ; Singapore/epidemiology* ; Telemedicine/statistics & numerical data* ; Homosexuality, Male/statistics & numerical data*

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

BACKGROUND: At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI. METHODS: Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups. RESULTS: Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs . 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs . 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs . 5.6, P <0.001). CONCLUSIONS It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
Humans ; Male ; Prostatectomy/methods* ; Prostatic Neoplasms/diagnosis* ; Middle Aged ; Aged ; Positron Emission Tomography Computed Tomography/methods* ; Biopsy ; Multiparametric Magnetic Resonance Imaging ; Prostate-Specific Antigen/metabolism*

OBJECTIVES

To determine the incidence of prostate cancer on follow up after an initial negative MRI- fusion biopsy of the prostate, and to determine the change in PSA and MRI results on follow-up.

MRI-fusion prostate biopsy registry from 2018 to 2022 was obtained then histopathology, MRI results, and PSA results were obtained. Repeat PSA and MRI results at extracted at 3 years. PSA mean, range, and change were then determined. MRI results were extracted to determine progression, regression, or persistence.

A total of 670 prostate biopsies were done in the study period, of which 70 were included. PSA on biopsy 9.93 (3.35 – 55.0) with corresponding PIRADS lesions 3, 4, and 5 (n=55, n=19, and n=6). No patient was subsequently diagnosed with prostate cancer on follow-up. PSA mean 7.03, 6.44, 5.27, and 6.07 at 3years interval from biopsy. Repeat prostate MRI showed persistence in 1 and regression in 6 patients.

After a negative MRI-fusion biopsy of the prostate no patient developed prostate cancer with a general decrease in trend in PSA and MRI on follow-up. These patients may have longer interval follow-up periods given the clinical scenario but would be best to test this method in prospective trials first.

INTRODUCTION

Testicular torsion is a true urologic emergency. It occurs when the blood supply to the testis is compromised as the vessels twist along the spermatic cord. Early diagnosis and prompt treatment are critical to prevent prolonged ischemia time which is crucial to its prognosis. This paper aimed to present cases of testicular torsion who underwent testis sparing surgery for torsion.

Cases of testicular torsion admitted at the institution from January 2023 to July 2024 were reviewed. Demographic data, scrotal ultrasound findings, intraoperative findings and ischemia time were documented. Patients who underwent tunica albuginea fasciotomy with tunica vaginalis flap were monitored post-surgery via scrotal ultrasound, documenting testicular size.

Twenty seven (27) cases of testicular torsion were reviewed. Of these cases, 4 improved after detorsion and orchidopexy, 12 cases with > 72 hours ischemia time and failed detorsion underwent orchiectomy, 11 cases with < 72 hours of ischemia time, tunica albuginea fasciotomy were performed. Five (5) of these 11 cases showed no improvement in appearance and no bleeding was observed and subsequent orchiectomy was performed. Six cases demonstrated improvement in appearance and bleeding after tunica albuginea fasciotomy, tunica vaginalis flap used to cover the resulting defect. Of these 6 cases, 2 cases showed intact testicular size, 1 case had testicular atrophy on monitoring and 3 cases were lost to follow-up.

Testicular torsion remains to be a critical urologic emergency. Prompt diagnosis and immediate surgery required to improve salvage rates. Tunica albuginea incision, with subsequent tunica vaginalis flap may be an option for the urologist to improve salvage, although not consistently prevent testicular atrophy.

INTRODUCTION: Testicular tumours in childhood have diverse characteristics for different age ranges. This study aimed to describe the pattern, presentation and outcomes of primary testicular tumours in a paediatric population. METHODS: A retrospective study was conducted from January 2010 to December 2020 on children (≤18 years) with a diagnosis of primary testicular tumour. Baseline demographics, clinical characteristics, pathology, treatment and outcomes of these patients were analysed. The data were entered into IBM SPSS Statistics version 20.0. Chi-square test and Fisher's exact test were applied to find the statistical significance, which was set at P value ≤ 0.05. RESULTS: The study included 115 males, with 85 (73.9%) patients in the prepubertal age range with a mean age of 2.53 ± 2.06 years and 30 (26.1%) patients in the postpubertal group with a mean age of 15.73 ± 1.25 years. Yolk sac tumour was the most common (62.6%) histological subtype. Majority (46.1%) of patients had stage I disease on presentation, while 29.6% had stage IV disease. All patients underwent upfront high inguinal radical orchiectomy, which was followed by platinum-based adjuvant chemotherapy in 67% of the patients. The five-year event-free survival and overall survival for all patients were 75% and 91%, respectively. CONCLUSION Primary testicular tumours follow a bimodal age distribution pattern. Majority of patients can be cured with platinum-based chemotherapy despite having advanced disease at presentation.
Humans ; Male ; Testicular Neoplasms/mortality* ; Retrospective Studies ; Adolescent ; Child ; Child, Preschool ; Orchiectomy/methods* ; Chemotherapy, Adjuvant ; Treatment Outcome ; Neoplasm Staging ; Infant ; Endodermal Sinus Tumor/therapy* ; Neoplasms, Germ Cell and Embryonal

Prostate cancer represents a prevalent malignancy within the male genitourinary system. In recent years, its incidence in China has gradually increased, becoming a significant public health issue. While early detection correlates strongly with improved prognosis, the majority of newly diagnosed prostate cancer patients in China are already in intermediate or advanced stages, precluding curative-intent interventions and contributing to marked survival disparities. The progression of prostate cancer is lengthy, typically encompassing diagnosis, treatment, progression, metastasis, and death, accompanied by a decline in quality of life. Personalized treatment plans should be developed based on the disease stage and patient preferences. In non-metastatic prostate cancer, where the tumor is confined to the prostate, surgery and radiotherapy are the primary treatments, supplemented by neoadjuvant and adjuvant therapies to delay metastasis. For metastatic prostate cancer, systemic therapy is prioritized to prolong survival. In metastatic hormone-sensitive prostate cancer, controlling androgen levels is crucial, while treatment options for metastatic castration resistant prostate cancer are relatively limited, necessitating individualized and precise treatment. During prostate cancer management, prostate-specific antigen levels are closely linked to prognosis and require monitoring. Bone metastasis, the most common site in prostate cancer patients, often triggers skeletal-related events, demanding effective prevention and management. Treatment-related adverse reactions are also a clinical challenge, requiring balanced risk-benefit assessments and judicious drug selection to preserve quality of life. Rapid advancements in screening technologies, surgical innovations, drug development, and China-specific epidemiological factors further complicate decision-making in holistic prostate cancer management. To optimize the standardization of prostate cancer diagnosis and treatment in China, the Genitourinary Oncology Committee of Chinese Anti-cancer Association synthesized global guidelines, clinical evidence and clinical expertise, and addressed critical challenges in the whole-course management of prostate cancer to formulate a multidisciplinary consensus. The expert consensus on whole-course management of prostate cancer (2025 edition) establishes standardized protocols to guide clinical practice, improve treatment outcomes, and enhance patient quality of life.
Humans ; Male ; Prostatic Neoplasms/diagnosis* ; Consensus ; Prostate-Specific Antigen/blood* ; Quality of Life ; Prostatic Neoplasms, Castration-Resistant/pathology* ; China ; Bone Neoplasms/secondary* ; Androgen Antagonists/therapeutic use*

Human papillomavirus (HPV) is one of the most prevalent sexually transmissible pathogens worldwide. In males HPV infection may lead to various diseases, including anogenital warts, anal cancer, oropharyngeal cancer, and penile cancer, with incidence rates of these conditions increasing in recent years across the majority of global regions. This expert consensus systematically reviews the epidemiological characteristics of HPV infection and its associated morbidities in males, delineates primary and secondary preventive strategies, and establishes recommendations in the following domains: public awareness and health education, vaccination strategies, and screening approaches. The goal is to provide theoretical foundations and practical guidance for reducing the burden of HPV infection and related diseases in males.
Humans ; Papillomavirus Infections/epidemiology* ; Male ; Consensus ; Papillomavirus Vaccines ; Penile Neoplasms/prevention & control* ; Human Papillomavirus Viruses