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Guidelines from the American Urological Association (AUA) and the European Association of Urology (EAU) present conflicting recommendations regarding combination therapy of phosphodiesterase 5 inhibitors (PDE5is) with α-blockers to treat benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Use of PDE5is is widespread in the population of patients with LUTS/BPH. In this scoping review, we examine the evidence regarding the safety and efficacy of combined PDE5is and α-blockers compared to PDE5i medications alone. A search was conducted using PubMed, Cochrane, and Web of Science to identify manuscripts discussing the safety of PDE5i and α-blockers in combination or comparing this combination to PDE5is alone in the treatment of LUTS/BPH. Study designs, data, and conclusions were qualitatively analyzed. Combination therapy was found to be safe across all studies; importantly, no evidence documents increased risk of hypotension. Most studies reported added improvement in symptom and quality of life scores compared to PDE5i alone, with additional International Prostate Symptom Score (IPSS) change ranging from −1.30 to −8.50 and IPSS quality of life score change ranging from −0.15 to −1.50. Objective metrics such as postvoid residual volumes and maximum flow rate were inconsistently reported. Taken together, the current body of data suggests that combining PDE5i α-blocker therapy is safe and that there are opportunities for additional symptomatic improvement, though it should be utilized for select patients. Situations with particular utility could include patients with comorbid erectile dysfunction or without sufficient improvement on monotherapy. KEY POINTS combination therapy with PDE5i and α-blockers is more effective than PDE5i medications alone for lowering IPSS combination therapy with PDE5i and α-blockers is not associated with a significantly greater number of adverse events than PDE5i medications alone the improvements seen in IPSS with combination therapy compared to PDE5i alone may or may not reach the threshold of clinical significance PDE5i and α-blocker combination therapy should be considered a safe regimen that can be used in appropriate clinical situations, like for patients with comorbid ED and those who do not achieve sufficient control of symptoms with a daily PDE5i alone [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Conclusions Microsurgical testicular sperm extraction (microTESE) is crucial for treating non‐obstructive azoospermia (NOA), offering both ‘fresh’ and ‘frozen’ options. This study evaluates the impact of fresh versus frozen microTESE on the progression to intra‐cytoplasmic sperm injection (ICSI) cycles, focusing on sperm motility.We conducted a retrospective analysis of microTESE procedures at a major medical centre from 2007 to 2021, excluding cases of obstructive azoospermia and cryptozoospermia. Patients were divided into two groups: fresh microTESE (Group FR) and frozen microTESE (Group FZ). Sperm motility was assessed, and ICSI outcomes were compared between groups.Out of 128 microTESE procedures on 113 NOA patients, 31 were fresh and 97 were frozen. Sperm was found in 67.7% of fresh cases and 45.3% of frozen cases. In fresh cases, 85.7% had motile sperm for ICSI, whereas in frozen cases, 81.8% had motile sperm initially, but only 52.7% retained motility post‐thaw.Our findings indicate a significant drop in motile sperm availability for ICSI in frozen microTESE cases compared to fresh ones. This suggests a potential advantage of fresh microTESE for certain couples, despite the logistical challenges, highlighting the need for careful patient selection and counselling. [ABSTRACT FROM AUTHOR]

Objective Materials and methods Results Conclusions Elevated sperm DNA fragmentation has potential implications for semen quality and fertility. The commonly used sperm chromatin dispersion test offers an indirect estimation but has limitations in terms of bias and variability. This study aimed to assess the reliability of the sperm chromatin dispersion assay for predicting assisted reproductive technology outcomes.This systematic review included studies published until December 2023 that adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed/MEDLINE, Scopus, and Google Scholar databases were searched. Various assisted reproductive technology outcomes in patients with high (≥ 30%) versus low (< 30%) sperm DNA fragmentation were compared using a sperm chromatin dispersion assay and including a sub‐analysis of intracytoplasmic sperm injection versus in vitro fertilization. A comprehensive meta‐analysis software facilitated quantitative analysis with statistical comparisons between cases and controls. Interstudy heterogeneity was assessed, and sensitivity and publication bias tests were performed.Of the 199 abstracts assessed, 64 full‐text articles were screened, and 44 articles were qualitatively synthesized. Fourteen articles representing 5346 participants were quantitatively analyzed. Using the sperm chromatin dispersion assay, elevated sperm DNA fragmentation was associated with lower fertilization and embryo cleavage rates. Notably, high sperm DNA fragmentation levels did not affect the clinical pregnancy, implantation, miscarriage, or live birth outcomes. Sub‐analysis revealed lower fertilization, embryo cleavage, clinical pregnancy, live birth rates, and higher miscarriage rates in the intracytoplasmic sperm injection subgroup only.The sperm chromatin dispersion assay did not show significant differences in pregnancy or live birth rates between the high‐ and low‐sperm DNA fragmentation groups. Noteworthy, high sperm DNA fragmentation was associated with worse assisted reproductive technology outcomes in the intracytoplasmic sperm injection group. Given the current quality of the evidence, affected by the experimental design and the absence of correction for female factors of infertility, clinicians should be wary of the assay's limited predictive power for pregnancy and live birth outcomes. [ABSTRACT FROM AUTHOR]

From bacillus Calmette-Guérin to cutting-edge research, the microbiome has played an integral role in urology treatments and will continue to do so for many generations to come., (Copyright © 2024. Published by Elsevier B.V.)

Purpose of Review: Infertility impacts one in six couples worldwide, with male infertility contributing to approximately half of these cases. However, the causes of infertility remain incompletely understood, and current methods of clinical management are cost-restrictive, time-intensive, and have limited success. Artificial intelligence (AI) may help address some of these challenges. In this review, we synthesize recent literature in AI with implications for the clinical management of male infertility., Recent Findings: Artificial intelligence may offer opportunities for proactive, cost-effective, and efficient management of male infertility, specifically in the areas of hypogonadism, semen analysis, and interventions such as assisted reproductive technology. Patients may benefit from the integration of AI into a male infertility specialist's clinical workflow. The ability of AI to integrate large volumes of data into predictive models could help clinicians guide conversations with patients on the value of various treatment options in infertility, but caution must be taken to ensure the quality of care being delivered remains high., (© 2024. The Author(s).)

Importance: Findings from several high profile meta-analyses have raised concerns about an ongoing global decline in sperm concentration and male fertility. However, these studies exhibit considerable heterogeneity in key variables including study population, methodology, fertility status, and geographic region., Objective: To perform a systematic review and meta-analysis exploring temporal trends in sperm concentration among fertile men and men unselected for fertility status in the United States., Data Sources: A literature search performed in Scopus and PubMed databases for studies published between 1970 and 2023. Additional studies were included from citations of prior global meta-analyses and reviews evaluating temporal trends in sperm count., Study Selection and Synthesis: Studies were included if they presented original data on sperm concentration in US men without known infertility from 1970 to 2023. Aggregate data were assessed across all study populations, with additional subgroup analyses stratified by fertility status and US region., Main Outcomes: Weighted generalized linear models were generated to evaluate the association between mean sperm concentration and sample collection year., Results: A total of 874 articles were screened, with 58 meeting the inclusion criteria. These represented 75 unique study populations totaling 11,787 men in the United States. Across all study populations, no change in sperm concentration was observed between 1970 and 2018 in unadjusted models (β = 0.14 million/mL per year). When adjusting for US region, no statistically significant decline in sperm concentration was seen. When adjusting for both region and fertility status, a modest annual decline was observed to meet statistical significance (β = -0.35 million/mL per year). Of the 49 study populations reporting adequate data to determine mean total sperm count, there was a significant increase in total sperm count of 2.9 million per year between 1970 and 2018. Subgroup analysis found no statistically significant change in mean sperm concentration among any US census region or fertility status cohort., Conclusion and Relevance: In contrast to prior global studies, this analysis suggests no clinically significant decline in sperm concentration among confirmed fertile men and the general male US population without known infertility. Although these findings provide some reassurance against a widespread rapid decline, further studies are necessary to better understand this important topic., Competing Interests: Declaration of Interests K.L. has nothing to disclose. R.C. has nothing to disclose. F.L. has nothing to disclose. B.R. has nothing to disclose. L.B. has nothing to disclose. J.M. has nothing to disclose. S. Kuribayashi has nothing to disclose. S. Kuroda has nothing to disclose. D.A.P. has nothing to disclose. S.C.V. has nothing to disclose. J.C. has nothing to disclose. S.D.L. has nothing to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)