Archives of Men's Health

Introduction:  Systemic lupus erythematosus (SLE) is an autoimmune disease more common in women than in men. This study analyzes the clinical, biological, immunological, and evolutionary features of lupus nephritis in men. Methods:  This study involved 25 male patients diagnosed with lupus nephritis between 2020 and 2024, selected from 90 lupus patients. All met the ACR or SLICC criteria and had kidney damage. Results:  The average age at diagnosis was 34.2 years (range: 16–51). Six patients were hypertensive, none were diabetic. Renal failure was observed in 15 patients, hematuria in 12, nephrotic syndrome in 15, and non-nephrotic proteinuria in 8. Most patients had lupus membranoproliferative glomerulonephritis (Class IV, 19 patients), followed by extra-membranous glomerulonephritis (Class V, 4 patients). Extra-renal involvement included hematological disorders (18 patients) and joint issues (16 patients), with two patients having antiphospholipid syndrome. For treatment, 21 patients received intravenous methylprednisolone and cyclophosphamide, while 4 received oral mycophenolate mofetil (MMF). Maintenance therapy was with MMF (4 patients) or azathioprine (15 patients). After two years, 8 patients achieved complete remission, 2 had partial remission, 5 relapsed, and 4 progressed to chronic kidney disease, including 2 with end-stage renal disease. Conclusion:  Lupus nephritis generally has a favorable course, although relapses and chronic kidney disease are observed. Personalized management is crucial for improving long-term outcomes.

Background:  Erectile dysfunction (ED) is a male sexual condition that affects 10% to 25% of men globally. Identifying the underlying cause of ED in males is a critical aspect of diagnosis. For many years, the Rigiscan® devices have been utilized to distinguish between psychological and physiological erectile dysfunction. The purpose of this study was to look at the validity of an Iranian erection analyzer equipment for evaluating nocturnal penile tumescence (NPT) in ED patients referred to Shahada-e-Tajrish Hospital in 2021. Materials and Methods: Patients who were diagnosed with vascular erectile dysfunction by doppler ultrasound evaluation and intra-cavernosal injection (ICI) test were included in this study. Also, a group of sexually healthy volunteers were included in the study as a control group. After receiving written informed consent, both groups were evaluated for two nights with the NPT test with the Iranian Erection Analyzer device. The results of the two groups were collected and analyzed. Results: A total of 45 patients with erectile dysfunction and 29 sexually healthy individuals were included in the study. Both groups were hospitalized for two nights in the isolation room of the urology ward and the NPT test was performed for them. Our results showed that the NPT test performed by the Iranian Erection Analyzer device with 62% sensitivity and 100% specificity is capable of distinguishing patients with erectile dysfunction from sexually healthy men. Conclusions: Based on our results, the Iranian Erection Analyzer device is accurate enough to diagnose patients with erectile dysfunction and can be used in clinics.

Introduction: Peyronie’s disease (PD) is characterized by the formation of fibrous, scar-like tissue in one or more areas of the tunica albuginea. Several potential risk factors for PD have been investigated. We aimed to evaluate the frequency of potential risk factors in PD patients. Methods: In this retrospective cross-sectional study, we included men diagnosed with PD who presented to a referral outpatient urology clinic between March 2019 and August 2024, in Tehran, Iran. Due to the relatively low prevalence of PD and the study's focus on specific risk factors within this population, purposive sampling was employed. The frequency of potential risk factors and the correlation between different risk factors were assessed.  Results: A total of 68 patients with PD were studied. The mean age of the disease onset was 53.7 ± 8.0 (range: 28–72) years. The most prevalent risk factors were DM in 20 (29.4%) patients and smoking in 18 (26.5%) patients. There was no significant difference regarding the frequency of risk factors between the two age groups of <55 and ≥55 years (P > 0.05 for all risk factors). Among patients with diabetes mellitus (DM), the median duration of DM since diagnosis was 8.5 (IQR: 2–30) years, while the median duration of hypertension among hypertensive patients was 10 (IQR: 4–20) years. For smokers, the median cumulative smoking exposure was 20 (IQR: 10 – 30) pack-years. Patients who developed PD before the age of 55 had a significantly longer duration of DM compared to those who presented with the disease at ≥55 years (15 vs. 5 years; p = 0.039). Correlation analysis revealed a strong positive correlation between the use of vasoactive erectile drugs and erectile dysfunction (r = 0.64). A negative correlation was observed between a history of penile trauma and age of PD onset (r = -0.40).  Conclusion:  Based on the findings of the present study, the most frequent potential risk factors were DM and smoking in this series of PD cases. The longer duration of DM may be associated with an earlier onset of PD and its presentation in ages < 55 years.

Background: Family tensions occur between parents and can be perpetrated by either partner, weakening the family foundation. Domestic violence against men by women is a prevalent yet understudied issue. This qualitative study aimed to explore the psychological and social factors that contribute to domestic violence against men by women. Methods: This qualitative study employed thematic analysis to explore the psychological and social factors contributing to family tensions and violence against married men by women in Iran. Married men who filed domestic violence complaints in Ilam, Iran (2023) participated in purposive group interviews. The recruitment process continued until theoretical saturation was reached, meaning no new themes emerged from subsequent interviews. A total of 16 men participated in the study. Semi-structured interviews with open-ended questions focused on participants' experiences with family tensions and violence. These interviews were audio-recorded with participant consent. Thematic analysis was employed to analyze the collected data, with themes and sub-themes identified and analyzed using MAXQDA 2022 software. Results: Thematic analysis revealed 112 codes, 30 subthemes, and 6 main themes that emerged as the underlying psychological and social factors contributing to domestic violence against men by women in the Iranian context. These main themes were: low psychological resilience, emotional dissatisfaction of the wife, gender role conflict, female chauvinism, marriage based on materialistic goals, and perceived violations of marital vows. Conclusion: Men with low self-esteem and societal pressures on gender roles were more likely to experience domestic violence by their wives. Interestingly, some wives held more power due to their financial or educational status. Materialistic marriages and broken vows further increased the risk of violence. These findings call for a multifaceted approach in Iran, addressing both men's mental health and societal issues, while also creating support systems for male victims.

Background:  Lymph Node involvement in patients with bladder cancer directly affects their prognosis after cystectomy. With the advent of various extensions for lymphadenectomy during radical cystectomy, Lymph Node Density (LND) has been introduced as a stable measure to quantify the extent of LN involvement. This study evaluates the prognostic value of LND on the survival of these patients in our center. Methods: Our historical cohort reviewed the clinical records of 165 patients who underwent cystectomy at Modarres Hospital in Tehran, Iran during 2012-2018. The presence of positive LNs, the total number of positive LN, and LN density were evaluated for their effect on Overall survival (OS) and recurrence-free survival (RFS) at 3- and 5-years post-surgery. In addition, we assessed the impact of age, gender, type of diversion, P stage, lymphovascular invasion (LVI), location of involved LNs, ureteral involvement, positive surgical margin, and the presence of carcinoma in situ on patients’ survival. Results: According to ROC curve analysis, an LND cut-off point of 10.82 was calculated to predict patients’ survival (AUC:0.70, 95%CI: 0.496-0.691). An LND >10.82 significantly increased the risk of cancer-related death. Among all study variables, LND had the most prominent effect on OS (HR:2.49, 95% CI:1.3-4.4, P=0.002). For 3- and 5-year RFS, LVI had the highest impact (HR: 2.63, 95% CI: 1.3-5.1, P=0.005 and HR: 1.96, 95% CI: 1.2-3.0, P=0.002, respectively) Conclusion: Our analysis indicates that an LND >10.82 has the highest predictive potential for OS among the pathological features of patients undergoing cystectomy.

Introduction: This study examines TXA as a fibrinolysis inhibitor and blood clot stabilizer to evaluate its effectiveness in improving patient outcomes, reducing blood transfusion rate, and the potential to shorten the surgery duration and hospital stay. Materials and Methods: In this prospective case-control study, 200 patients with kidney stones candidates for Percutaneous nephrolithotomy (PCNL) surgery referred to Tehran's Shohada Tajrish Hospital were selected. In this regard, 100 of them, who received tranexamic acid during the surgery, were allocated to the case group, and the other 100 who did not receive it were assigned to the control group. Statistical tests were used to compare the data between the two groups. Results: The results revealed that 200 patients with kidney stones, with a mean age of 43.38, including 126 males and 46 females, were included in the study. The frequency distribution of demographic data and clinical findings between the two case and control groups was similar (p>0.05). Tranexamic acid administration in the case group compared with the control group reduced the need for blood transfusion by 81 % and reduced the mean surgery period by 21.34 minutes. Additionally, the hemoglobin drop in the case group was significantly lower than that in the control group (P<0.05). The mean change of creatinine did not show a significant difference between the two groups (P>0.05). Conclusion: The results indicate that the prescription of tranexamic acid during PCNL surgery effectively prevents bleeding and hemoglobin drop and reduces the need for blood transfusions and surgery periods without causing specific renal complications.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and disabling urological disorder that affects quality of life in men. Despite accounting for most prostatitis cases, its causes remain unclear, involving immune dysregulation, oxidative stress, microbial factors, and epithelial barrier dysfunction. This uncertainty complicates diagnosis and treatment.
Proteomics offers a high-throughput approach to identify proteins and pathways involved in CP/CPPS. Recent studies have profiled urine, seminal plasma, prostatic secretions, and serum to uncover biomarkers linked to inflammation, oxidative stress, and microbial virulence. These findings provide insights into molecular endotypes, guide new classifications, and point toward novel therapeutic targets such as cytokine signaling, pyroptosis pathways, and heat shock proteins. Although technical variability and small cohort sizes remain major challenges, integration of proteomics with multi-omics platforms and explainable AI may transform CP/CPPS management by enabling personalized diagnostics and targeted interventions.

Background: Reproductive health is a focal point for governments during this epidemiological transition. By adopting innovative research strategies, reproductive health research centers can determine priorities and practical measures. They can also take impactful steps toward protecting family development and decreasing the population's average age through knowledge production. Therefore, this study is designed to investigate the knowledge production in reproductive health research centers in Iran during 2017-2021. Methods: Reproductive health research centers active for 5 or more years were evaluated during 2017-2021. In this study, three main axes including stewardship, knowledge production, and impact were evaluated with 15 key indicators. Results: This evaluation included 28 research centers related to reproductive and family health with at least 5 years of activity across 17 universities of medical sciences or organizations affiliated with the Ministry of Health in Iran. The final scores were calculated by summing the scores across the different axes. Based on the overall score, the top three research centers include (1) the Reproductive Biomedicine Research Center at the Academic Center for Education, Culture, and Research (ACECR), (2) the Reproductive Biotechnology Research Center at the (ACECR) and (3) the Preventive Medicine and Public Health research center at Iran University of Medical Sciences. Conclusion: Mission-oriented research activities in reproductive health research centers with the priority of treating infertility and childbearing care are effective in reducing the problem of population aging.

Introduction: Intractable hematuria due to advanced urological malignancies or radiation cystitis presents a major therapeutic challenge, especially in patients unfit for surgery. Selective arterial embolization (SAE) is a minimally invasive option for achieving hemostasis in such cases. Methods: We retrospectively reviewed 12 patients treated with SAE between 2021 and 2025 for persistent hematuria caused by bladder cancer (n=7), radiation cystitis (n=3), or prostate cancer (n=2). Embolization was performed using super selective catheterization and Embospheres (500–700 µm). Clinical success was defined as significant or complete resolution of hematuria without additional invasive treatment. Results: Clinical success was achieved in 9 (75%) patients and technical success in 10 (83%). Three patients required further interventions, including one cystectomy. No major complications were reported. Most (75%) patients tolerated the procedure well without recurrence. Conclusion: SAE is a safe and effective palliative treatment for refractory hematuria, offering meaningful symptom relief and reducing the need for major surgery in high-risk patients.

Neoadjuvant chemotherapy (NAC) has been a standard treatment in the management of muscle-invasive bladder cancer (MIBC), especially for cisplatin-eligible patients. However, its widespread adoption is hampered by unresolved controversies. Various systematic reviews and meta-analyses support the role of NAC in improving survival. While in a meta-analysis published by Li G and colleagues in 2017, no difference in Overall Survival (OS) was observed between the group receiving NAC and the group that did not receive NAC (1). In addition to its advantages, it is necessary to examine its possible disadvantages and challenges.

Subclinical Varicocele (SV) remains one of the most controversial entities in male infertility management. Although major guidelines do not recommend treatment, growing evidence suggests that microsurgical repair may benefit selected patients. This review critically examines current guidelines, available clinical evidence, potential mechanisms of damage, and patient selection strategies. Emerging

biomarkers and personalized approaches may help redefine management. While routine surgery for SV is not justified, individualized decision-making may bridge the gap between evidence and clinical need [1,2].

The Men's Health and Reproductive Health Research Center is addressing a critical challenge: the health needs of a vital segment of society that is often overlooked. Men, who represent half of the population, play an essential role in family and societal security. Their health is intrinsically linked to economic, social, cultural, and overall health development.

Research reveals a concerning trend: men are generally less healthy than women, engage in riskier lifestyles, and exhibit lower levels of health awareness (1). They are more susceptible to various health risk factors, highlighting the urgent need for targeted interventions to enhance their well-being. Increasing health awareness through planning, training, and education is paramount. Furthermore, the prevalence of primary infertility in Iran stands at 18.3%, with 32% of cases attributed to unexplained causes, 12.5% to female causes, and 13.6% to male causes. As in many countries, infertility presents significant psychological and social challenges for Iranian couples (3).

The issue of infertility affects millions of couples in Iran (4), carrying substantial implications for both individual and societal well-being. Comprehensive healthcare services for this demographic are crucial, especially considering population policies aimed at fostering healthy families.

Male infertility accounts for approximately half of all cases in couples unable to conceive. Beyond routine semen analysis, sperm DNA integrity measured by the DNA Fragmentation Index (DFI) is emerging as a key indicator of reproductive potential. DFI represents the percentage of sperm with damaged DNA and is associated with poorer reproductive outcomes, including reduced chances of natural conception, ART failure, and increased miscarriage rates. This narrative review examines the biological mechanisms underlying sperm DNA fragmentation, the clinical relevance of DFI in infertility evaluations, available laboratory methods for DFI assessment, and therapeutic strategies. Although interventions like varicocelectomy and antioxidant therapy show promise, the quality of evidence varies. We conclude by discussing current limitations and future directions in this evolving field.

The coronavirus was the causative agent of a global epidemic from 2019 to 2022. The viral effect on sexual health and hormonal profile plus the rate of healthy births are important issues in general health. In this review, we studied the effect of coronavirus on reproductive health using more than 70 articles to understand the interaction of the virus with the reproductive system.

High temperatures due to fever elevated ACE2 expression in both testis germ and somatic cells. Furthermore, they exhibit significantly elevated luteinizing hormone (LH) levels, but decreased testosterone, LH, and follicle-stimulating hormone (FSH)/LH ratios, which may indicate the possibility of hypogonadism and/or infertility. In contrast, women diagnosed with SARS-CoV infections during the first trimester of pregnancy are at a higher risk of spontaneous miscarriages, while infections occurring during pregnancy are more likely to result in preterm delivery.

The Coronavirus can theoretically and potentially affect men’s fertility and sexual development, and possibly cause miscarriage in the first trimester of pregnancy with an unknown mechanism. The findings cannot affirm whether the hormonal alterations are due to a direct/indirect effect of the virus. Therefore, more studies are needed to answer related questions.

Prostate cancer (PCa) remains a leading cause of cancer mortality in men globally. Age, genetic predisposition, and inflammation are the major risk factors. Increasing evidence suggests that oncogenic viruses, HPV types 16/18, could be involved in prostate carcinogenesis. This review critically examines the potential association between HPV infection and prostate cancer, including both molecular mechanisms and epidemiological evidence. We conducted a narrative literature review by systematically searching PubMed, Scopus, and Google Scholar for papers published from 2013 to 2025. We used search terms such as prostate cancer, HPV, oncogenic viruses, and viral carcinogenesis. We reviewed several peer-reviewed papers that involved molecular information, clinical documentation, and meta-analytic data. The evidence reports HPV DNA in 15-36% of PCa tissues, the most common being HPV-16/18. Mechanistically, HPV proteins (E6/E7) inactivate central tumor suppressors (p53, Rb), activate anti-apoptotic proteins (Bcl-2, survivin), and induce changes associated with cancer onset (through N-cadherin/TWIST), as observed in HPV-positive anogenital cancers. Genomic signatures reveal that HPV-positive PCa has characteristic patterns of mutation (e.g., KMT2C/D disruption). Nonetheless, heterogeneity across HPV detection assays and small sample sizes in a few studies call for cautious interpretation.

 Today, we have data suggesting that HPV may cause PCa, possibly through inflammation (NF-κB) and unstable genes; however, the exact mechanism remains unclear. We require large trials in many centers and additional screens to determine the role of HPV in this. As we can prevent HPV, these findings suggest that HPV vaccines could be of critical importance in preventing PCa. We must find out more.