Erectile dysfunction (ED), a condition affecting nearly 150 million men worldwide, is expected to impact over 300 million by 2025. Phosphodiesterase type 5 inhibitors (PDE5Is) remain the first-line treatment for ED, yet a subset of patients exhibit inadequate responses. For these individuals, the inflatable penile prosthesis (IPP) offers an effective alternative, with the three-piece IPP being particularly favored for its high satisfaction and low complication rates. However, the challenge of optimal reservoir placement, particularly in the extraperitoneal space of Retzius (SOR), has prompted investigations into alternative approaches. SOR placement is associated with complications, such as injury to iliac vessels, bladder puncture, and bowel perforation. Various alternative sites have been proposed, including epigastric extraperitoneal, intraperitoneal (IP), high submuscular (HSM), and lateral retroperitoneal (LRP) positions, each aiming to mitigate these risks while improving patient outcomes. Comparative studies have shown that methods such as IP and HSM reduce the risk of vessel compression and bladder injury, often yielding higher satisfaction rates compared with SOR. However, each technique carries unique drawbacks, including risks of palpability, improper placement, and longer operative times. This review synthesizes current evidence on reservoir placement strategies, evaluates their advantages and limitations, and highlights crucial considerations for patient selection, providing a comprehensive overview of IPP implantation techniques and their evolving roles in the management of ED.

Cryptorchidism is recognized as a significant risk factor for male germ cell tumors and infertility, with a complex and multifaceted mechanism contributing to male infertility. When the testes fail to descend into the scrotum, increased local temperature and pressure lead to increased apoptosis of spermatogenic and Sertoli cells. Additionally, disruptions in the hypothalamic-pituitary-gonadal axis result in decreased testosterone levels within the testes, and abnormal secretion of follicle-stimulating hormone and luteinizing hormone, negatively impacting spermatogenesis. Cryptorchidism also induces increased oxidative stress within the testes, leading to sperm DNA damage and impairment of the sperm plasma membrane, hindering sperm-oocyte fusion. Unilateral cryptorchidism may cause injury to the ipsilateral genitofemoral nerve, further affecting the contralateral testis by increasing oxidative stress and apoptosis. Moreover, the production of antisperm antibodies can trigger autoimmune responses, potentially damaging germ cells and contributing to infertility. Damage to type A dark spermatogonia (type Ad spermatogonia) is also considered a high-risk factor for male infertility. Understanding the mechanisms by which cryptorchidism leads to male infertility may provide new avenues for enhancing fertility in affected patients.

To evaluate the prognostic significance of prostate-specific antigen (PSA) decline depth and duration in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC) undergoing abiraterone treatment. We retrospectively analyzed data from 153 high-risk patients with mHSPC receiving first-line abiraterone therapy. Patients were stratified based on PSA dynamics during treatment. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to assess the associations between PSA decline patterns, PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS), and overall survival (OS). Among the 153 patients, 85 exhibited PSA nadir <0.2 ng ml-1, 48 had PSA nadir level ranging from 0.2 ng ml-1 to 4 ng ml-1, and 20 presented with a PSA nadir >4 ng ml-1. During abiraterone treatment, PSA nadir <0.2 ng ml-1 was significantly associated with improved median PSA-PFS (51.0 months vs 18.5 months vs 6.9 months, P < 0.0001), median rPFS (52.0 months vs 24.3 months vs 10.3 months, P < 0.0001), and median OS (not reached vs 48.5 months vs 28.1 months, P < 0.0001) compared with PSA nadir ≥0.2 ng ml-1 and <4 ng ml-1, and PSA nadir ≥4 ng ml-1. In the cohort with PSA nadir <0.2 ng ml-1, achieving PSA <0.2 ng ml-1 within 6 months and maintaining this level for over 10 months significantly enhanced clinical outcomes, as evidenced by median PSA-PFS (not reached vs 26.9 months, P < 0.0001), median rPFS (not reached vs 27.5 months, P < 0.0001), and median OS (not reached vs 44.4 months, P < 0.0001). Cox regression analysis revealed that achieving PSA <0.2 ng ml-1 within 6 months post-treatment and sustaining this level for over 10 months are independent prognostic factors. In high-risk patients with mHSPC receiving first-line abiraterone, sustained PSA suppression is a key indicator of therapeutic response. The rate, depth, and duration of PSA decline are critical prognostic factors.

Non-obstructive azoospermia (NOA) represents one of the most severe forms of male infertility, with spermatozoa retrieval only possible in about half of the cases. Spermatids can be identified in up to 30% of men with negative spermatozoa during testicular sperm extraction (TESE) procedure. Intracytoplasmic spermatid injection has been proposed for TESE-negative patients desiring biological parenthood. However, significant limitations jeopardize the clinical implementation of this technique. Key challenges include the accurate identification of viable spermatids and the need for artificial oocyte activation. These limitations contribute to lower fertilization, pregnancy, and live birth rates compared to conventional intracytoplasmic sperm injection using mature sperm. Additionally, the absence of rigorous randomized controlled trials and the predominance of low-quality and outdated underpinning studies have significantly jeopardized its clinical implementation. These concerns have led the Practice Committee of the American Society for Reproductive Medicine to consider the technique experimental. Recent advances in microscopy, improved tissue processing, and refined activation techniques have enhanced outcomes. Furthermore, while initial safety concerns about epigenetic modifications persist, follow-up studies of spermatid injection offspring have shown normal development. This review comprehensively explores current evidence regarding intracytoplasmic spermatid injection techniques, focusing on their utilization, efficacy, and safety in men with NOA. We also evaluate spermatid identification and retrieval methods, ethical considerations, technical limitations, and emerging technologies that could enhance outcomes.

Men with erectile dysfunction offered penile prostheses have high satisfaction rates when properly counselled. These devices have undergone significant advancements in design, surgical techniques, and perioperative management, enhancing patient outcomes, satisfaction, and safety. This review summarizes the latest innovations, including novel non-antimicrobial prevention strategies and disposable surgical tools that may reduce infection risks. Furthermore, advances in operative techniques, including safer alternative reservoir placement, have minimized the complications. Additionally, innovations in postoperative management, such as multimodal analgesia and nerve blocks, have improved patient recovery and comfort. Lastly, emerging technologies, including shape-memory alloys and electronic-controlled devices that represent potential future breakthroughs are described.

Androgen insensitivity syndrome (AIS) is a condition that emerges from mutations in the androgen receptor (AR) gene, leading to functional defects and subsequent abnormal development of the urogenital sinus. The aim of this study was to investigate the relationship between genotype and phenotype, surgical treatments, and complications of AIS patients. We retrospectively evaluated the medical records of patients who were diagnosed with AIS after genetic testing and underwent initial surgery at Beijing Children's Hospital, Capital Medical University (Beijing, China), from August 2007 to August 2023. A total of 46 patients were included in this study. Four novel variants, p.Y572S, p.L57dup, p.L882del, and p.V888A, were identified. AR variants are concentrated in the ligand-binding domain (LBD) region (60.9%) and are predominantly missense mutations (78.3%). There was no significant difference in the phenotypes between the LBD group and the non-LBD group (P > 0.05). Nonsense or frameshift mutations may accompany more severe phenotypes or complete androgen insensitivity syndrome (CAIS; P = 0.011). For CAIS patients with inguinal hernias, we recommend that hernia ligation surgery should be performed during childhood and that gonadectomy should be considered during adolescence or postadolescence. Preoperative hormone stimulation (PHS) had a positive effect on penile growth (P = 0.0014). Compared with patients with severe hypospadias, those patients with partial androgen insensitivity syndrome (PAIS) experience fewer complications from urethroplasty. If the conditions for a one-stage operation are not adequately met, it is advisable to perform staged surgery.

Artificial intelligence (AI)-driven large language models (LLMs) hold potential for medical applications but face challenges, such as inaccurate or outdated training data. In this study, ZhongdaChat-ED, a personalized medical LLM integrating retrieval-augmented generation (RAG) technology, was developed to enhance erectile dysfunction (ED) counseling and clinical decision-making. The model was built using the open-source Deepseek-r1:32b framework, augmented with two specialized databases: a patient health consultation database and a clinical decision support database updated with real-time medical advancements. Two versions of ZhongdaChat-ED were developed: a Consumer Version for patient-facing health consultations and a Professional Version for clinician support. Performance was evaluated against four commonly used LLMs (ChatGPT4, Copilot, Claude, and Gemini) through simulated clinical consultations and case analyses. Three urologists and three patients assessed responses across various dimensions, including accuracy, human caring, ease of understanding, clinical significance, and informational frontier. The Consumer Version outperformed commonly used LLMs in accuracy (4.77/5), human caring (4.86/5), and ease of understanding (4.88/5) with all P < 0.001. The Professional Version demonstrated significantly higher clinical significance (>85.2% case score rate) and informational frontier scores (4.52/5) than those of other models (P < 0.001). ZhongdaChat-ED effectively addresses limitations of conventional LLMs by leveraging RAG to integrate real-time, domain-specific data. ZhongdaChat-ED shows promise in enhancing patient health consultation and clinician decision-making for ED, underscoring the value of tailored AI systems in bridging gaps between generalized AI and specialized medical needs. Future work should expand multimodal capabilities and cross-disciplinary integration to broaden clinical utility.