Fendereski Kiarad, Ghaed Mohammad Ali, Calvert Joshua K, Hotaling James M
Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Department of Urology, Rasoul Akram Hospital, Iran university of Medical Sciences, Tehran, Iran.
Transl Androl Urol. 2022 Jul;11(7):1045-1062. doi: 10.21037/tau-22-308.
Previous studies indicated that the treatment of male hypogonadism can be beneficial for intraoperative and postsurgical outcomes. In this study, we aimed to determine the impact of male hypogonadism on urologic surgeries. We provided an overview of the key studies in the field with the focus on the outcomes of urologic surgeries in hypogonadal men with/without testosterone replacement therapy (TRT).
We performed a literature review in PubMed and Google Scholar databases for the most relevant articles pertaining to the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer reviewed journals between January 1970 and March 2022.
Androgen deficiency is a common finding after major urologic surgeries. Although guidelines recommend against TRT in men with prostate carcinoma, recent investigations showed no association between TRT and disease progression and recurrence. Indeed, recent evidence suggested that low androgen levels could be related to high grade prostate carcinoma and increased risk of upgrading from low to high grade disease. Investigations on the application of TRT in benign prostatic hyperplasia (BPH) patients also revealed contrasting results. While some studies suggested higher rates of prostate-related events in men who received TRT, others showed that TRT could alleviate urinary symptoms in hypogonadal men with BPH. Decreased testosterone level is commonly seen in bladder cancer patients. The treatment of perioperative androgen deficiency can reduce postoperative morbidities and lower the risk of recurrence in these patients. Low testosterone levels are observed in approximately half of the men who undergo artificial urinary sphincter (AUS) placement and can increase the risk of complications.
The role of testosterone treatment in patients with urologic diseases such as prostate carcinoma and BPH is controversial. Further investigations are needed to determine the impact of hypogonadism and TRT on the outcomes of urologic surgeries in patients with androgen deficiency.
既往研究表明，男性性腺功能减退的治疗可能对手术中和术后结局有益。在本研究中，我们旨在确定男性性腺功能减退对泌尿外科手术的影响。我们概述了该领域的关键研究，重点关注接受/未接受睾酮替代疗法（TRT）的性腺功能减退男性的泌尿外科手术结局。
我们在PubMed和谷歌学术数据库中进行了文献综述，以查找与上述主题最相关的文章，对发表年份或研究设计不设任何限制。我们纳入了1970年1月至2022年3月在同行评审期刊上发表的英文全文文章。
雄激素缺乏是大型泌尿外科手术后的常见现象。尽管指南建议前列腺癌患者不要进行TRT，但最近的研究表明TRT与疾病进展和复发之间没有关联。事实上，最近的证据表明，低雄激素水平可能与高级别前列腺癌以及疾病从低级别升级到高级别的风险增加有关。对TRT在良性前列腺增生（BPH）患者中的应用研究也得出了相互矛盾的结果。一些研究表明，接受TRT的男性发生前列腺相关事件的发生率较高，而另一些研究则表明，TRT可以缓解性腺功能减退的BPH男性的尿路症状。膀胱癌患者中常见睾酮水平降低。围手术期雄激素缺乏的治疗可以降低这些患者的术后发病率并降低复发风险。在接受人工尿道括约肌（AUS）植入的男性中，约有一半观察到睾酮水平较低，这可能会增加并发症的风险。
睾酮治疗在前列腺癌和BPH等泌尿系统疾病患者中的作用存在争议。需要进一步研究以确定性腺功能减退和TRT对雄激素缺乏患者泌尿外科手术结局的影响。
