While semen analysis has historically been used exclusively to evaluate male fertility, recent evidence indicates that abnormal semen parameters may reflect underlying health problems extending beyond reproduction, with research demonstrating notable links between irregular semen characteristics and heightened risk for chronic conditions including prostate cancer, diabetes, heart disease, and metabolic dysfunction.

This multi-institutional case series examined the use of fine-needle vasography (FNV) to identify obstruction sites and assess candidacy for reconstructive surgery in men with suspected obstructive azoospermia or cryptozoospermia, including patients with azoospermia or cryptozoospermia, palpable vasa, testicles ≥12 mL, and FSH <7.6 IU/L who underwent testicular biopsy to confirm spermatogenesis. The FNV procedure utilized a 25-gauge angiocatheter with radio-opaque dye visualized under fluoroscopy, with results reported as median and interquartile range.

The relationship between low testosterone and atherosclerotic cardiovascular disease (ASCVD) risk and mortality remains unclear due to conflicting evidence across existing studies. This cross-sectional study analyzed data from 1.1 million male patients aged ≥18 years in the Houston Methodist CVD Learning Health System Registry (June 2016-April 2022), excluding those on testosterone replacement therapy, to evaluate the independent associations between total testosterone levels (categorized into quartiles) and ASCVD outcomes including coronary artery disease, peripheral artery disease, and stroke using logistic regression with ICD-10-CM codes.

Men with hypogonadal symptoms and normal total testosterone (TT >300 ng/dL) but low enzyme-linked immunoassay free testosterone (FT <7.9 pg/mL) are typically not offered testosterone therapy despite potential benefits, prompting this prospective analysis of 86 consecutive men treated with testosterone cypionate 200 mg intramuscularly every two weeks with follow-up at 3 and 6 months. Results demonstrated that 89.5% of patients reported substantial improvement in energy and libido after 6 months, with mean IIEF-5 scores improving from 12.8 to 14.7 (p=0.07), though 11.6% developed erythrocytosis and 4.8% experienced PSA elevation, suggesting that men with hypogonadal symptoms, normal TT, and low EIA-FT can respond well and safely to testosterone therapy.

Clomiphene citrate (CC) is used off-label to treat hypogonadal men seeking to preserve or improve fertility, but predictors of treatment response remain unclear, prompting this retrospective analysis of 151 hypogonadal men treated with CC from 2010-2014 at two institutions to examine relationships between demographic factors, pre-treatment laboratory values, treatment duration, and changes in semen parameters. Results from 81 eligible patients showed significant improvement in progressive motility (23% to 30%, P<0.05) and a trend toward improved sperm concentration (14 to 19 million/mL, P=0.059) with no change in seminal volume

Erectile dysfunction significantly impacts quality of life, and while a spectrum of treatment options exists, novel therapies are being developed to delay or prevent the need for penile prosthesis placement in treatment-refractory cases. This review, utilizing MedLine and FDA Clinical Trials Registry data, examined innovative treatments currently in development including alternative vasoactive agents, trophic factors, bio-compounds, gene therapy, and stem cell therapy, with recent studies demonstrating potential for multiple novel approaches, though large-scale, blinded, placebo-controlled trials remain necessary to bring these products to market.

Chronic idiopathic orchialgia is a common and challenging urologic condition with no consensus on management, though most providers agree that initial treatment should be medical and symptom-focused after ruling out other treatable organic causes such as structural abnormalities, torsion, trauma, post-operative pain, infection, or referred pain. This review examines the evidence for various pharmacotherapies commonly used to treat idiopathic chronic orchialgia—also termed chronic epididymitis, chronic testicular pain, chronic orchidynia, or chronic scrotal pain syndrome—which may involve neural inflammation similar to other complex regional pain syndromes and demonstrates an established but poorly understood relationship with depression, supporting the use of multiple medical management approaches prior to considering more invasive interventions despite incomplete understanding of the underlying pathophysiology.

Previous research demonstrated that feeding C57BL/6 mice a high-fat diet (45% daily calories from fat) induced obesity, hyperglycemia, and insulin resistance, prompting examination of corpus cavernosum tissue for hyperinsulinemic effects, comparison of miR-93 expression between high-fat diet and control mice, and intracorporal pre-miR-93 injections in some animals to measure levels of three miR-93 targets. Results showed multiple findings consistent with erectile dysfunction in high-fat diet mice, including abnormalities in corporal endothelium-dependent and endothelium-independent vasoreactivity, decreased smooth muscle-to-collagen ratio, and reduced NADPH diaphorase staining.

Patients at high risk for bladder cancer (age ≥50 years, ≥10 pack-years smoking history, and/or ≥15 years environmental exposure) were enrolled in a one-time screening trial using nuclear matrix protein 22 (NMP22) assay between March 2006 and November 2007 at Dallas Veterans Affairs Hospital to evaluate long-term outcomes and assess subsequent detection of smoking-related malignancies including bladder, lung, and renal cell carcinoma through January 31, 2014. Multivariable regression analysis was used to determine factors associated with bladder cancer diagnosis and survival in this high-risk cohort.

Retry

Existing hypospadias outcome tools have limited focus on caregiver and patient perspectives regarding patient-centered outcomes, prompting collaboration with patients, caregivers, and lay and medical experts to develop and pilot a patient-reported outcome measure based on systematic literature review and focus group input. The measure was piloted in caregivers of boys younger than 8 years and in patients older than 8 years presenting for urology consultation before meeting with the surgeon, with patients classified as having uncorrected hypospadias, successful repair, or failed repair based on the presence or absence of complications including fistula, diverticulum, meatal stenosis/stricture, greater than 30-degree recurrent curvature, glans dehiscence, and/or skin reoperation.

This study presents an updated experience with a lateral perineal "7-flap" technique for perineal urethrostomy in patients with advanced urethral stricture disease, reviewing all patients who underwent the procedure from 2009-2013, in which a "7"-shaped laterally based perineal skin flap was advanced into a spatulated, amputated bulbomembranous urethra with the contralateral side matured to the advanced perineal skin. Among 748 patients undergoing urethroplasty during the study period, 22 men (2.9%; mean age 61, range 31-80) with advanced stricture disease received a 7-flap perineal urethrostomy (mean follow-up 32 months), with patients stratified by body mass index for outcome comparison.

This study presents a novel ventral slit with scrotal skin flaps (VSSF) technique for adult buried penis reconstruction without skin grafting, in which an initial ventral slit is made in the phimotic ring to expose the penis, followed by creation of local flaps through a ventral midline scrotal incision with horizontal relaxing incisions that are rotated to resurface the ventral shaft. Among 15 consecutive patients (mean age 51 years, mean BMI 42.6 kg/m²) with penis trapped due to lichen sclerosus or phimosis treated in the outpatient setting with no perioperative complications, 73.3% remained satisfied with results requiring no further intervention, though three patients (20%) experienced recurrences due to lichen sclerosus, panniculus migration, or concealment by edematous groin tissue, with two undergoing subsequent successful skin grafting, demonstrating that VSSF is a versatile, safe, and effective reconstructive option for appropriately selected patients with buried penis syndrome.

Laparoscopic extravesical detrussoraphy (LED) for managing vesicoureteric reflux in children with complex bladders and/or bilateral VUR was evaluated in 98 patients with 144 ureters over 8 years, with complex bladders defined as those with previous surgery on the affected side, neurogenic bladders, or duplex/complex anatomy. The procedure achieved 95.2% overall VUR resolution with average length of stay of 1.7 days for children ≥5 years and 1.0 days for children <5 years, urinary retention in 6.5% of bilateral cases versus 0% in unilateral cases, and among 27.6% of patients with complex bladders (including complete ureteral duplications, periureteral diverticula, and prior surgery), only two complications (7%) required second procedures with no persistent VUR, demonstrating that LED is a safe, effective, and versatile technique with high resolution rates and minimal morbidity.