Men's Health Journal

Background: Despite the increasing attention to the role of the father and its importance in child development, little research has been done in this area compared to the mother's role. Methods: In this article, the father's role in child development was systematically reviewed from the perspective of different theoretical approaches as well as different cultures. Results: The findings showed that the role of men as fathers is changing and evolving from a mere breadwinner to a supporter. Most new generation fathers seek to participate in their children's lives and are more caregiving and emotionally responsive than the previous generation. Fathers have a unique role in raising children, which is different from the mothers’ role. The role of the father varies under the influence of culture and social structure. In Asia economic problems have changed the clear definition of the role of father. In the Middle East, Islamic beliefs determine the role of the father as the head of the family. In Europe, the role of the father as a participant and responsible person is improving. The modernization of society in Africa has complicated gaining a coherent and clear image of the father’s role for children. In North American countries, parents play an almost equal role in raising children. Expectations from fathers are vague in South America, but these expectations seem to be changing more rapidly. Conclusion: Studies confirm the important role of fathers in parenting from different psychological approaches and the change in men's definition of fatherhood. However, the father's roles are different in different cultural and social contexts.

Introduction: Social distance is important for reducing the spread of the new COVID-19 pandemic, especially in public places. In addition, urban stores are one of the crowded places where observing social distance is considered necessary. Therefore, the present study aimed to evaluate the social distance between customers in urban stores during the outbreak of the COVID-19 pandemic using a simulation method. Materials and methods: Research data were collected from the closed-circuit television footage of a store from a hypermarket in Iran, and then customers’ social distance was analyzed through their movement behaviors by two modes of 1 and 2-meter distance using software similar to the Pathfinder simulator. Further parts of the urban store required corrections considering the first scenario and the two-meter distance between people compared to the second scenario and the one-meter distance between them. Results: Based on simulation results, dense areas were identified in different sections of the hypermarket, namely, places where the shelves distance was 1 meter to 2 meters. More precisely, this research provided a method for evaluating different parts of the store in terms of population density regarding maintaining social distance. Conclusion: several suggestions were presented to stores for maintaining social distance based on research findings.

Background: We aimed to investigate the association between prostate specific antigen (PSA) density and Gleason score of the positive surgical (PSM) margin after radical prostatectomy with biochemical recurrence in patients with prostate cancer.  Materials and Methods: In this retrospective cohort study, patients with prostate cancer referred to Hasheminejad Hospital in Tehran, Iran, during 2009-2019, who underwent radical prostatectomy were enrolled through the convenience sampling method. The follow-up period was determined as at least one year after radical prostatectomy to determine biochemical recurrence. Prostate-specific antigen density (PSAD) and the Gleason score of surgical specimen and positive surgical margins (PSM) were evaluated and their association with biochemical recurrences was investigated. Results: One hundred and three patients were assessed. The overall biochemical recurrence rate was 48.5% with a mean follow-up of 24 months (12-42 months) and an average time to biochemical recurrence of 18 months (16-20 months). BCR-free (Biochemical recurrence-free) survival rates of patients divided based on the PSAD cut-off point (0.205 ng/ml/cc) were significantly different using the log-rank test (P= 0.008) (85.7%, 57.1%, and 14.3% for values ≤ 0.205 ng/ml/c versus 55.8%, 20.9%, and 0% for values ˃ 0.205 ng/ml/cc, respectively for 1-, 2- and 3-year survival). Moreover, Cox regression showed that the Gleason score of PSM, the Gleason score of the surgical specimen, and the PSAD predicted biochemical recurrence more, respectively. Conclusion: PSAD and PSM Gleason scores were strong predictors of biochemical recurrence after radical prostatectomy and their use along with other common indicators including tumor grade and stage and PSA level can increase the accuracy of risk assessment in patients with prostate cancer.

Introduction:  Atypical infections are often considered as a potential etiology for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We aimed to describe the prevalence of atypical infections in this patient population to inform clinical management for male patients complaining of pelvic pain.  Methods: We retrospectively reviewed patients at a single center from January 2016 to January 2019. We included patients with CP/CPPS Type III diagnosed with pelvic or genital pain in the absence of bacterial infection. All patients underwent an atypical infection panel. The primary outcome measure was the presence of any atypical infection. Results: In total, 345 patients met the inclusion criteria. Of those, 9/345 (2.6%) had an atypical infection (5 mycoplasma and 4 ureaplasma). The mean age of patients with positive atypical infections was 34 compared to the overall study population (44 years, P=0.01). Two patients with atypical infections were also followed for infertility. Urinalysis was available for 6 of the 9 patients with positive atypical infection: 50% (3 out of 6) were normal and 50% (3 out of 6) had >5 WBC/hpf. Symptoms resolved in 66% (2 out of 3) of the patients with positive atypical infection with available follow-up data. Conclusion: Atypical infectious agents were uncommon causes of CP/CPPS. Screening for atypical microbes such as chlamydia, ureaplasma, or mycoplasma may not be necessary for male patients complaining of pelvic or genital pain.

Introduction: Urethral, penile, and scrotal cancers are rare and represent less than 1% of all malignancies. However, they are associated with a high mortality rate and have a significant effect on patients’ quality of life. Penile and urethral cancers comprise 0.6% of all urological cancers. Because of ethnic, geographical, and cultural diversity, risk factors and cancer patterns vary in different communities. We aimed to provide valid information on the prevalence, incidence, and epidemiology of urethral, penile, and scrotal cancers using the National Registry on Cancer of Iran. Methods: This retrospective study of 465 patients included all known cases of urethral, penile, and scrotal cancers from the Department of National Registry on Cancer at the Ministry of Health and Medical Education in Iran during 2004-2015. This study examined the demographic characteristics of patients and discussed the risk factors and possible causes of the above-mentioned cancers. Results: The mean ±SD age at the time of registration was 58.49±20.82 years. The highest and lowest proportions of cases belonged to Tehran/Alborz (14.2%) and Mazandaran (0.65%) provinces, Iran, respectively. Regarding the distribution of records according to a year of registration, these cancers were more prevalent in 2014, and less prevalent in 2004. Conclusion: Urethral, penile, and scrotal cancers were more common in Tehran and Alborz. There was a strong possibility that the prevalence of these cancers is linked to the industrial nature of Tehran and Alborz and the prevalence of human papillomavirus.

Introduction: Self-efficacy is a construct that can greatly influence sports development. Individuals with a high self-efficacy level are more likely to set tougher goals and work harder to achieve them. We aimed to investigate the relationship between sports aggression and sports mindfulness with sports self-efficacy in male athletes through the mediating role of family cohesion. Material and Methods: The statistical population of this descriptive-correlational study covered all male athletes who are members of the youth and adult male football teams in Masjed Soleyman (Iran) in 2021. The 258 athletes were selected using convenience sampling. The research tools included the Sports Self-Efficacy Questionnaire, the Buss-Perry Aggression Questionnaire, the Mindfulness Inventory for Sport, and the Family Cohesion Questionnaire. The proposed model was evaluated using path analysis and indirect correlations were tested with bootstrapping. Results: The results suggested that all direct paths to sport self-efficacy were significant except sports mindfulness (P<0.01), and indirect paths to sports self-efficacy became significant through family cohesion (P<0.01). Conclusion: The proposed model had a good fit, and was a major step toward recognizing the factors affecting sports self-efficacy in male athletes, and can help in designing programs to reduce their experienced tension and improve their sports self-efficacy.

Introduction: Prostate cancer is the second most common cancer after lung cancer worldwide. In 2018, there were 1276106 new cases and 3.8% (358989 cases) of the population who died of this cancer were men. (What do you mean? All were men because we are talking about prostate cancer, but do you mean the mortality rate?) We aimed to evaluate men's knowledge, attitudes, and performance toward prostate cancer. Materials and Methods: A descriptive analysis was done on 385 men in the urology clinic of Imam Khomeini Hospital. Men aged at least 40 with no history of prostate cancer were included in this survey. The researchers made a questionnaire including two parts: the first part comprised information about knowledge, attitudes, performance, and the second part consisted of demographics. The men’s function was divided into two groups according to performing the PSA test: the good function group (PSA tests were done) and the weak function group (PSA tests were not done).  Data analyzed were analyzed using SPSS software, version 20. Results: The mean±SD age of the men was 63.9±8.9 years and 56.6% of them were city dwellers. 22.7% had a university degree. Most (38.5%) were Self-employed and most (76.3%) had no family history of prostate cancer. Most participants answered the general questions about prostate cancer, but they did not have suitable and reliable information about related risk factors, diet, and sexual activity. ‌ Conclusion: Considering the positive effect of people's knowledge on their attitude and their attitude on their performance, by holding training classes and education for people at risk their attitude and ultimately their performance towards prostate cancer prevention would be improved.

Introduction: Diabetic male patients are more likely to have ED and subnormal testosterone levels than non-diabetic men. We aimed to estimate the prevalence of ED and low serum testosterone level in diabetic men, and to study the patient’s age, duration of diabetes, body mass index (BMI), glycosylated hemoglobin (HbA1c) and spot urine albumin to urine creatinine ratio (uACR) as risk factors for ED, and their correlation with serum total testosterone level. Methods: This was a cross-sectional observational study, including 103 male patients aged 30-60 years, diagnosed with type 2 diabetes mellitus (T2DM). Patients with score less than 22 on the abridged 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were diagnosed to have ED, and patients with serum total testosterone level less than 2.3ng/ml (8nmol/L) were considered to have low serum testosterone. Results: The prevalence of ED was 46.6%, and that of low testosterone level was 18.4%. Men with ED had significantly higher prevalence of testosterone deficiency than those without ED (31.3% vs 7.3%, P=0.004). Mean age of the patient (50.73±7.22 vs 47.51±8.67 years, P=0.045), mean duration of diabetes (10.66±5.56 vs 8.53±5.60 years, P<0.001), mean BMI (28.51±4.05 vs 24.51±3.32 kg/m², P<0.001), and mean HbA1c (8.49±1.15 vs 7.70±1.05 %, P<0.001) were higher, while mean total testosterone level (3.18±1.65 vs 4.61±1.92 ng/ml, P<0.001) was lower in patients with ED, compared with those without ED. Total testosterone level negatively correlated with BMI (R=-0.682, P<0.001), HbA1c (R=-0.279, P=0.004), and uACR (R=-0.241, P=0.014); and positively correlated with IIEF-5 questionnaire score (R=0.519, P<0.001). BMI (P<0.001) and uACR (P=0.048) independently and negatively correlated with total testosterone level. Conclusion: ED is a common complication in Indian men with T2DM. Excess weight is a risk factor for ED as well as low testosterone level. Older age, longer duration of DM and poor glycemic control are risk factors for ED, and presence of microalbuminuria is associated with low testosterone level. Serum testosterone levels should be measured in diabetic men suffering from ED.

Introduction: With the emergence of the worldwide COVID-19 pandemic, a high toll of mortality and morbidity was imposed on Iran. Despite endeavors to control the disease using the social distancing protocols, isolations, quarantine and vaccination, COVID-19 is still afflicting individuals by mutation and development of new variants. Studies suggest higher morbidity and mortality among men compared to women, and in men with underlying diseases. Studies suggest low serum testosterone level as a risk factor for more severe diseases. We aimed to assess the relation of testosterone level with laboratory investigation and its effect on COVID-19 disease outcomes. Materials and Methods: Seventy patients were selected from those referred to Shohada-e-Tajrish hospital during February 2022 till July 2022. The patients were further categorized in two groups regarding their need for respiratory support: patients who did not need invasive respiratory support and patients who needed invasive respiratory support and were admitted to the intensive care unit. Blood samples were collected for laboratory examination. Each patient was followed for one month, and the outcomes were recorded. Results: The mean age of the participants was 64.44 years including 33 men and 37 women. Mean serum total and free testosterone level was 0.45 nmol/L and 1.22 nmol/L, respectively. Demised patients were significantly older and had significantly lower total testosterone levels. D-dimer was significantly higher in demised patients. Conclusion: Serum total testosterone levels can be used as a prognostic factor to predict COVID-19 patients’ prognosis. Serum total testosterone is inversely associated with disease severity, and lower serum total testosterone level is significantly associated with higher mortality. Moreover, inflammatory markers such as D-dimer can be used to determine prognosis and severity.

Background: Emotional divorce is the first stage of divorce in which the marital relationship deteriorates and the couple's relationship lacks love and affection. Given that the family is one of the foundations of the society, emotional divorce can have devastating effects on society and negative effects on family members. Therefore, it is essential to study this issue. Methods: Patients with Pelvic Fracture Urethral Distraction Defect (PFUDD) admitted consecutively to Shohada-e-Tajrish Hospital (Tehran, Iran) from May 2020 to May 2021 were enrolled in the study. In this study all patients were evaluated by two questionnaires: Gottman emotional divorce questionnaire to assess the patient's marital status, and the International Index of Erectile Function (IIEF-5) questionnaire to assess the patient's sexual situation.  Results: The mean score for the IIEF-5 scores in the case and control groups were 18.32 and 21.04, respectively. The mean Gottman Scores in the case and control groups were 3.84 and 2.12, respectively. There was no significant difference between IIEF-5 and Gottman Scores between the two groups. Conclusions: Considering the lack of differences between the two groups, it can be inferred that the effect of the spiritual and emotional dimension in strengthening marriage was more than the physical dimension. When a man encounters a physical problem, his wife will play a supportive role and seek to strengthen relationship and solve problems.

Background: A criterion for the right termination of marriage is a disadvantage of the spouse, which burdens the other party. To solve this problem, defects are considered for couples in jurisprudence and law, and if they are incurable, the marriage contract is terminated. In this study, we examined the awareness and attitude of medical personnel about this issue. Methods: In this descriptive-analytical study, which was done in the first half of 2021, the personnel of Shohada Tajrish and Shahid Modares hospitals were evaluated using a researcher-made data collection form. The effects of demographic factors (age, sex, marriage, and education) were also investigated. Sampling was done by census method and employed according to the inclusion criteria. Cochran's formula was used to calculate the minimum sample size. Fisher and Pearson’s statistical tests in SPSS21 software were used for data analysis. Results: The knowledge and awareness of the participants in all age groups under the study was similar (P>0.2). All participants were aware of insanity as an obstacle to marriage and were unaware of other diseases leading to marriage termination. After learning that 10 to 11 diseases caused the annulment of marriage, they added all the incurable diseases to this list, and they had a negative attitude towards these restrictions. Conclusion: Most medical personnel had little awareness about the number of marriage annulment cases. There was a negative attitude toward discrimination between men and women in the number of these diseases.

Introduction: Substance abuse is a major psychosocial disorder that causes irreparable physical and mental damage based on the different personal, social, and personality characteristics of each person. We aimed to investigate the mediating role of diffuse-avoidant identity in the relationship between moral intelligence and family functioning with addiction potentials of male adolescents. Materials and Methods: In this descriptive-correlational study, multistage cluster sampling was used to enroll 315 individuals among all male adolescents studying in Tehran, Iran, in 2021. The research instruments included the Addiction Potential Scale (APS), the Moral Intelligence Questionnaire (MIQ), the Family Assessment Device (FAD), and the Identity Style Inventory (ISI). The proposed model was assessed using structural equation modeling (SEM), and indirect relationships were examined using the bootstrapping method.  Results: The results revealed that addiction potentials significantly and negatively correlated with moral intelligence and family functioning. Moreover, addiction potentials significantly and positively correlated with diffuse-avoidant identity (P<0.01). The direct paths from all variables (except that from family functioning) to addiction potential were significant (P<0.01). Also, diffuse-avoidant identity meditated the relationships of moral intelligence and family functioning with addiction potential (P<0.01). Conclusion: The proposed model fitted the data well; therefore, the results considerably improved our understanding of factors affecting addiction potential among male adolescents.

Introduction: Nephrolithiasis is almost common urological disease in the world that involves near 10 percent of adult population. Several researches are demonstrative of increasing prevalence and incidence of nephrolithiasis in industrial societies, because of changing the life style, food regimen and obesity that is very common. Though prevalence of nephrolithiasis in grafted kidney is rare, but because of importance of effects after grafting or graft rejection is needed to attention and study. Methods: In this research incidence of nephrolithiasis and the difference of it before and after the kidney transplantation in graft receiver of kidney in Urmia Imam Khomeini hospital for two years in 2018-2019 has studied, and followed after one year. Relation between age, education level, and sex have been evaluated too. Results: In this study 32 receiver of kidney transplant have been studied. Among this 32 patient 3 cases had nephrolithiasis after transplantation that they didn’t have any history of nephrolithiasis, And 3 cases had history of nephrolithiasis that after transplantation no kidney stone was seen (P<0.05).Higher prevalence of nephrolithiasis was significantly related to higher level of education (p<0.05), but age and sex was not significantly different in two groups (P>0.05). Conclusion: It’s concluded that the main reason of nephrolithiasis is the kidney organ that can make stone in the new body, and level of education was higher in the nephrolithiasis group (affected or have the history) than the healthy group.

Background: Vestibular schwannoma (VS) is an extra-axial, benign tumor mostly located in the cerebellopontine angle. The goal of VS surgery is gross total resection of the tumor along with preservation of the cranial nerves’ function. Intraoperative nerve monitoring is mainly rewarding in VS surgery. Method: This Cohort study was done retrospectively and prospectively from 2011-2021. Patients were divided into two groups; group one (n=19) underwent resection of the tumor with intraoperative neuromonitoring and group two underwent resection of the tumor without neuromonitoring based on patients’ ability to economically afford neuromonitoring. In the neuromonitoring group, Somatosensory Evoked Potential (SSEP) was evaluated and recorded throughout the whole surgery.  Motor Evoked Potential (MEP) was recorded at regular intervals as well. We compared tumor size, hemorrhage volume during surgery, length of surgery, and facial nerve preservation (HB score), with one-year follow-up. Result: Facial nerve (FN) anatomical preservation rates were 100% and 75% in the neuromonitoring and control groups, respectively. The Gross Total Resection (GTR) rate in group one was 78.9%. The Subtotal Resection (STR) and Partial Resection (PR) rates in procedures without neuromonitoring were 50.0% and 12.5%, respectively. The House-Brackman (HB) level was good in all patients in group one, while 68.8% of patients in the control group had poor HB. Conclusion: Intraoperative Neuromonitoring (IONM) in VS surgery helps increase anatomical nerve preservation rate and FN outcome. The coordination of a anatomically trained neurophysiologist along with real-time video-assisted nerve monitoring avoids and lowers any delay in nerve recognition.

Premature Ejaculation (PE) is a common male sexual dysfunction. But its diagnosis is still a challenge for clinicians (1). People are either reluctant to approach doctors with their sexual problems or those who approach health care providers are reluctant to ask for proper history (2). Although being the most common sexual dysfunction, there is no clear-cut case definition or criteria for the clinical diagnosis which can be used in day-to-day practice.

Objective: To conduct a systematic review and meta-analysis to provide an estimate of the prevalence of anxiety disorders during 2010-2020 among Iranian men.  Methods: We searched international and national databases including PubMed, Scopus, Cochrane library, SID, and Magiran with related keywords. The selected studies were also qualitatively evaluated using the Newcastle-Ottawa Scale (NOS) checklist. I² test was used to measure the heterogeneity of the studies and a random strategy for meta-analysis was considered using the result. Results: We reviewed 782 articles identified through our search. Then, 51 articles were selected according to the inclusion criteria and, data were extracted from 24 articles. After carefully reviewing these articles, 24 articles were ultimately selected for meta-analysis. The overall estimated prevalence of anxiety among men was 12% (95% CI: 0.11, 0.13). The highest prevalence of anxiety was 50% (95%CI: 0.38-0.62) in Tehran and the lowest prevalence of anxiety was 0.014% (95%CI:0.003-0.025) in Shiraz. Conclusions: Anxiety disorders are common and the substantive identified here explain much of the prevalence of mental disorders. These results showed the potential in men to suffer from anxiety disorders.

Since 31 December 2019, the coronavirus disease 2019 (COVID-19) resulted in a state of hyperinflammation syndrome and multiorgan failure. In areas with pandemic outbreaks, despite several emerging vaccines, supportive treatments to mitigate fatality rates were required. Growing evidence suggests that several small RNAs such as microRNAs (miRNAs) and short interfering RNA (siRNA) could be candidates for the treatment of COVID-19 by inhibiting the expression of crucial virus genes. small RNAs by binding to the 3′-untranslated region (UTR) or 5′-UTR of viral RNA play an important role in COVID-19-host interplay and viral replication. In this review, the authors sought to specify the efficacy and safety of miRNAs and siRNA expressions of patients with COVID-19, which has an axial role in the pathogenesis of human diseases.

Background: The management of hallux valgus is important in orthopedic surgery. The purpose of the current study was to look into the techniques for reducing pain after surgery for hallux valgus. Method: The results of this study were obtained by reviewing English-language papers about foot and ankle surgery that were published in the PubMed and Scopus databases between 1991 and 2021. Ultimately 41 articles were retrieved. Results: Based on the results of this study, systemic steroids and opioids, when used without paracetamol, non-steroidal anti-inflammatories, and cyclo-oxygenase inhibitors II, can be used properly to provide analgesia during hallux valgus surgery. Conclusion: Postoperative analgesics and sciatic nerve blocks in conjunction with other techniques are used to manage the pain after this procedure.

Men's Health Journal (MHJ) is a Peer-reviewed journal that started working under the chairmanship and editorship of Dr. Jalil Hosseini, (MD, Professor of Urology) since 2017. MHJ journal is one of the journals at Shahid Beheshti University of Medical Sciences, Tehran, Iran. MHJ's mission is to study all aspects of Men's health and illness (Research, Clinical, and Theoretical articles). 18 articles published in 2022, have been authored by more than one hundred researchers from countries, including the United States, India, and Iran such as Shahid Beheshti University of Medical Sciences, Tehran University of Medical Sciences, “Isfahan, Urmia, Ahvaz, Ardabil, Hamedan, Semnan, Shahrood” University. The articles submitted in 2022 have been reviewed by more than a hundred reviewers, and we appreciate the reviewer who cooperated with the journal to improve the quality of the articles.