Search Results (450)

Erectile dysfunction (ED) is one of the most prevalent and disabling complications of diabetes mellitus (DM), thought to arise from the interaction of metabolic, vascular, and neural injury. Recent evidence indicates that diabetic neuropathy, affecting both somatic and autonomic pathways, plays a central role in the development of ED and is strongly associated with increased disease burden. Early neurophysiological studies documented impaired penile sensory conduction and abnormalities of sacral reflex pathways in diabetic men with ED, while more recent investigations have confirmed the contribution of cardiovascular autonomic neuropathy and small-fibre loss. At the molecular level, oxidative stress, advanced glycation end-product signalling, impaired nitric oxide bioavailability, and reduced neurotrophic support, particularly involving brain-derived neurotrophic factor (BDNF), emerge as key mechanisms linking diabetes to neural and neurovascular dysfunction. Although phosphodiesterase type-5 inhibitors remain first-line therapy, reduced responsiveness in patients with significant neuropathy highlights the importance of recognising the role of neurogenic mechanisms. Overall, the available evidence supports the conceptualisation of diabetic ED as a neurovascular manifestation within the broader spectrum of diabetic neuropathy rather than as a purely vasculogenic disorder. This review integrates historical and contemporary literature addressing the epidemiology, neurophysiology, pathophysiology and therapeutic implications of ED in diabetes, with a specific focus on its neuropathic substrate. These findings support a paradigm shift toward an integrated neurovascular approach to diabetic ED, highlighting the importance of early neuropathy-oriented assessment and paving the way for future regenerative and neuroprotective therapeutic strategies. Full article

Background: With the rapid advancement of artificial intelligence (AI), its applications in andrology are expanding across diagnostic assessment, preoperative planning, intraoperative assistance, and postoperative management. This narrative review aims to synthesize current evidence regarding AI applications across the spectrum of andrological surgery. Methods: A comprehensive literature search was conducted using the PubMed, Scopus and Web of Science databases to identify relevant studies published between January 2020 and October 2025. The search strategy utilized combinations of keywords including “artificial intelligence,” “andrology,” “erectile dysfunction,” “male infertility,” “microsurgery,” and “robotic-assisted surgery.” Original research and review articles published in English were selected based on their clinical relevance to surgical practice. Results: AI has shown promise in the evaluation and management of erectile dysfunction (ED), male infertility-related microsurgery, and complex reconstructive procedures. AI-based models can improve risk prediction and diagnosis of ED, standardize semen analysis, support individualized selection of surgical candidates for varicocele repair and other interventions, and augment microsurgery through enhanced visualization and decision support. In the postoperative phase, AI-driven tools are being explored for complication prediction, functional recovery monitoring, and long-term quality-of-life follow-up, enabling more patient-centered, continuous care. Conclusions: AI holds significant promise for advancing precision medicine in andrological surgery by enhancing objective assessment and intraoperative guidance. However, large-scale, standardized datasets and rigorous multi-institutional validation are needed. Establishing robust ethical and legal frameworks will be essential to ensure the safe and effective integration of AI into routine andrological care. Full article

Background/Objectives: Sexual dysfunction is highly prevalent in men with chronic kidney disease (CKD), but longitudinal data across the CKD spectrum, particularly those directly comparing non-dialysis CKD with haemodialysis, are limited. We aimed to characterise longitudinal patterns in erectile and broader sexual function over three years, focusing on persistent between-group stratification and change over time in men with CKD versus community controls, and to identify clinical predictors of poorer outcomes. Methods: We conducted a three-year prospective cohort study in three groups of adult men: a group on haemodialysis, a group with non-dialysis CKD stages 3A/3B, and age-matched community controls without known kidney disease. The primary endpoint was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-15), assessed annually; the IIEF-15 total score and remaining domains were the secondary outcomes. Participants’ health-related quality of life (EQ-5D-5L), age, and diabetes status were recorded. Linear mixed effects models with participant-level random intercepts estimated the effects of group, year, and group × year, adjusted for age, EQ-5D-5L, and diabetes. Results: We enrolled 267 men (haemodialysis n = 96; CKD n = 88; and controls n = 83). At every time point, EF and other IIEF-15 domain scores showed a graded pattern with controls being the highest, CKD being intermediate, and haemodialysis the lowest. group × year interactions were not significant, indicating parallel trajectories without differential decline between groups over three years. Having a lower EQ-5D-5L, an older age, and diabetes—particularly type 2—were independent predictors of poorer IIEF-15 scores across domains. Conclusions: Male sexual function in CKD is persistently and gradually impaired along the renal disease spectrum, with patients on haemodialysis faring the worst and with no evidence of divergent longitudinal change. Routine EF screening, systematic attention to patients’ quality of life, and aggressive management of diabetes should be embedded in CKD care pathways, and renal-appropriate erectile dysfunction interventions should be considered earlier and more systematically. Full article

Background/Objectives: Taiwan cinnamon leaves have been reported to be effective in improving chronic diseases. Herein, cinnamon leaf extract (CLE) and nanoemulsion (CLEN) were prepared to explore their effects in improving sexual dysfunction in rats. Methods: Following extraction with 80% ethanol and analysis by UPLC-MS/MS, CLEN was prepared using an optimal ratio of soybean oil, lecithin, Tween 80, deionized water, and CLE. A total of 48 male rats and 48 female rats were used, with the former being induced with erectile dysfunction, followed by treatment with CLEN or CLE at two doses (100 mg/kg and 50 mg/kg) for 4 weeks. After conducting the penile reflex test, male rats were paired with female rats for measurement of sexual behavior and ICP/MAP. Following sacrifice, α-SMA, nNOS, and β-III tubulin expression areas were measured by histochemical analyses; SMC/collagen ratio by Masson’s trichrome staining; and NO, cGMP, and PDE5 levels by ELISA kits. Results: CLEN was more effective than CLE in increasing intromission frequency, decreasing intromission and ejaculation latency, and recovering erectile response for improving copulatory and ejaculatory performances. A higher maximum ICP/MAP ratio was shown for CLEN through elevation of neurovascular function and erectile capacity. Additionally, CLEN efficiently reduced fibrosis, enhanced neuronal marker expression, and increased the SMC/collagen ratio, leading to penile tissue protection and neural regeneration. Both treatments showed elevated levels of NO and cGMP with a reduction in PDE5, probably through modulation of the NO-cGMP signaling pathway. Conclusions: CLEN was more effective than CLE in restoring erectile function in rats. Some more clinical trials are needed to verify this finding. Full article

Background/Objectives: Penile prosthesis implantation is a safe and effective treatment for erectile dysfunction, with low complication rates. Glans ischemia is a rare but serious postoperative complication that can lead to irreversible tissue loss. However, not all postoperative glans color changes reflect true ischemia, and distinguishing reversible from irreversible perfusion compromise remains challenging. The objective was to describe the clinical course, management, and outcomes of four patients who developed glans color changes following penile prosthesis implantation, emphasizing the role of glans sensibility in guiding treatment. Methods: We conducted a retrospective case series supplemented with a narrative literature review. Clinical data were obtained from medical records, operative reports, and follow-up visits. Literature searches were performed using PubMed, Scopus, and Google Scholar. Results: Four patients developed postoperative glans discoloration. Two patients, with preserved glans sensibility and no evidence of tissue necrosis, were managed conservatively with cylinder deflation and removal of compressive dressings, resulting in full recovery without tissue loss. Two patients, who exhibited impaired glans sensitivity, developed progressive ischemia. One had prior pelvic radiation, and the other underwent combined grafting and glanspexia. Both required surgical debridement and reconstruction, with permanent tissue loss. Conclusions: Glans color changes after penile prosthesis implantation do not always indicate irreversible ischemia. Preserved glans sensibility is a useful clinical marker of potentially reversible perfusion compromise and may support a conservative management strategy with close monitoring. Conversely, loss of sensation and necrosis should prompt urgent consideration of prosthesis explantation to prevent further tissue loss. Full article

Objectives: Transperineal (TP) prostate biopsy is increasingly used because of its lower complication rates compared with the transrectal approach. However, prospective data regarding its effects on erectile and ejaculatory function remain limited. This study prospectively evaluated short-term sexual function outcomes after TP prostate biopsy in sexually active men. Methods: This single-center prospective observational cohort study included men undergoing TP prostate biopsy between 15 April 2025 and 1 September 2025. Indications for biopsy were prostate-specific antigen levels >4 ng/mL, abnormal digital rectal examination findings, or suspicious lesions (PI-RADS ≥ 3) on multiparametric prostate MRI. Sexual function was assessed at baseline and at 1 and 3 months after biopsy using the International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Results: Overall, 249 sexually active men were analyzed. No significant changes in erectile or ejaculatory function were observed in the overall cohort at either follow-up point. In contrast, among 132 men diagnosed with prostate cancer, significant declines were observed in IIEF-5, PEDT, and MSHQ-EjD-SF scores at both 1 and 3 months compared to baseline (all p < 0.001). Conclusions: Transperineal prostate biopsy minimally affects sexual function in the general population. However, prostate cancer patients experience notable deterioration in erectile and ejaculatory outcomes, which may be a transient decline, and long-term follow-up is necessary for this subgroup. Full article

Background/Objectives: Interest in the use of nutraceuticals and phytotherapy for the management of andrological diseases has increased markedly in recent years. In particular, growing attention has been directed toward the treatment of patients affected by erectile dysfunction (ED), male infertility, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and induratio penis plastica (IPP). However, several areas of uncertainty remain. This narrative review aims to examine the role of nutraceuticals and phytotherapeutic agents in the management of andrological disorders. Methods: A narrative review was conducted using PubMed, Scopus, Cochrane CENTRAL, and EMBASE to identify relevant studies published over the past 25 years. Only articles published in English and involving adult populations were included in the analysis. Results: Nutraceuticals and phytotherapeutic compounds have been extensively investigated in the current literature, and certain formulations—particularly specific combinations—have been evaluated in high-quality studies. Conversely, other compounds lack sufficient scientific evidence and therefore should not be recommended in routine clinical practice. In the management of ED, the following compounds, administered either alone or in combination, have demonstrated clinically significant effects: Panax ginseng, Tribulus terrestris, L-arginine, and Withania somnifera. L-carnitine, combined with micronutrients, antioxidants, and various traditional herbal supplements, appears to be an effective therapeutic option for male infertility and subfertility. Pollen extracts play an important role in the management of CP/CPPS, while carnitine, coenzyme Q10, silymarin, bromelain, and curcumin show promising potential in the treatment of IPP. Conclusions: Nutraceuticals and phytotherapeutic agents may provide favorable outcomes in the management of andrological diseases. Although current evidence is encouraging, larger prospective studies employing standardized protocols and treatment schedules are required to confirm long-term efficacy and to optimize therapeutic strategies. Full article

Background/Objectives: Prostate cancer (PC) is one of the most commonly diagnosed malignancies globally; depending on the treatment strategy used, erectile dysfunction (ED) is a frequently reported adverse outcome among PC patients. The current study evaluated ED prevalence among Pakistani PC patients and its effects on physical, psychological, and social well-being, aiming to address critical gaps in survivorship care for this population. Methods: A cross-sectional, multicenter, observational, questionnaire-based study was conducted in Rawalpindi and Islamabad, Pakistan, from February to April 2025. Health-related quality of life (HRQoL) among PC patients was measured using the Short Form Health Survey 36 (SF-36), while ED prevalence and severity were assessed by the International Index of Erectile Function (IIEF) instrument. Results: Among N = 400 PC patients, surgical treatments predominated (radical prostatectomy: 61.0%; n = 244), while hormonal (androgen-deprivation therapy: 31.5%; n = 126) and chemotherapy (23.3%; n = 93) were also commonly utilized. ED experience was high among PC patients in the erectile function (40.8%; n = 163) and in the intercourse satisfaction (45.0%; n = 180) domains; these showed moderately strong and significant positive correlations across all SF-36 domains, particularly physical functioning (r = 0.52; p < 0.001) and social functioning (r = 0.49; p < 0.001). Regression analysis confirmed sexual function domains explained 60% of HRQoL variance (adjusted R² = 0.60). Conclusions: This study reveals high rates of treatment-related ED—and its biopsychosocial impact–among Pakistani PC patients, with significant negative impacts on HRQoL. The findings underscore the urgent need to integrate sexual health management into standard oncological care practices to improve holistic patient outcomes. Full article

Sickle cell disease (SCD) is an inherited hemoglobinopathy in which hemoglobin S polymerization drives hemolysis and vaso-occlusion with progressive organ morbidity. Male reproductive impairment is increasingly recognized but remains underreported. This narrative review summarizes mechanistic pathways, clinical manifestations, and fertility preservation options relevant to men with SCD. PubMed, the Cochrane Library, and Medscape were searched through 31 December 2025 for human studies addressing endocrine changes, semen quality, priapism and erectile dysfunction, oxidative stress, and treatment-related gonadotoxicity. Evidence supports converging mechanisms: recurrent vaso-occlusion and chronic hypoxia may injure the seminiferous epithelium and impair Leydig cell steroidogenesis; oxidative stress and inflammation contribute to sperm DNA and membrane damage; and disease-modifying or curative therapies such as hydroxyurea and hematopoietic stem cell transplantation can further compromise spermatogenesis. Clinically, men with SCD may present with oligozoospermia, azoospermia, hypogonadism, and sexual dysfunction, particularly after recurrent ischemic priapism. Fertility preservation should be discussed early, ideally before prolonged hydroxyurea exposure or transplantation, and may include semen cryopreservation and testicular sperm extraction (TESE) with assisted reproduction when needed. Prospective longitudinal studies are required to define reproductive trajectories and optimize counseling and management. Full article

Background and Objectives: Peyronie’s disease (PD) is a chronic fibrotic disorder of the tunica albuginea causing penile deformity and sexual dysfunction. Platelet-rich plasma (PRP) has been proposed as a regenerative therapy with potential disease-modifying properties, but evidence of its use in chronic PD is scarce. This study evaluated the efficacy and safety of intralesional PRP injections in men with stable PD. Materials and Methods: A single-center retrospective cohort study was conducted including men with chronic PD treated with three weekly intralesional PRP injections (April 2022–April 2025). Inclusion required curvature stability for ≥6 months and absence of prior PD therapy. The primary outcome was a change in penile curvature at 4 weeks post-treatment. Secondary outcomes included plaque thickness (ultrasound), erectile function (IIEF-5), and safety (Clavien–Dindo grading). Results: Thirty-six men (mean age 61.2 ± 10.4 years) completed the treatment. Mean penile curvature decreased from 30.5 ± 7.3° to 24.2 ± 8.3° (Δ = −6.3°, 95% CI −7.7 to −5.3; p < 0.001); 25% achieved a ≥10° reduction. Mean plaque thickness declined from 3.25 ± 0.69 mm to 2.91 ± 0.76 mm (Δ = −0.34 mm; p < 0.001). IIEF-5 increased modestly (+1.1; p = 0.142). Only mild, transient adverse events occurred (pain 5.6%, hematoma 2.8%). Conclusions: Intralesional PRP was safe and yielded statistically significant but modest reductions in penile curvature and plaque thickness in chronic PD. Clinically meaningful improvement occurred in a minority of patients. These findings support keeping PRP investigational pending well-designed randomized controlled trials with standardized protocols and longer follow-up. Full article

With emerging improvement in screening and treatment, most patients with prostate cancer (PCa) live for a long period beyond their diagnosis. Erectile dysfunction (ED) and bowel and urinary incontinence have been shown to be the most bothersome side-effects of most PCa treatment options for patients. With increasing long-term survival, most PCa patients face the prospect of experiencing symptoms, side-effects of available treatment options, and diminished quality of life. The objective of the study was to explore the impact of treatment-induced ED on masculinity among Black South African PCa patients. Twenty (20) prostate cancer patients, selected through purposive sampling and receiving some form of treatment at Pietersburg tertiary Hospital, with ages ranging from 67 to 85 years (mean age = 76 years; SD = 5.3), participated in the study. In-depth, individual semi-structured interviews were used to collect data and analyzed through Interpretative Phenomenological Analysis (IPA). The findings indicate that ED threatens or adversely impacts the participants’ perceptions of their sense of masculinity leading to diminished quality of life. The results demonstrate that loss of masculinity brought about by PCa treatment-induced ED is experienced both physically as well as psychologically. The results highlight a need for collaboration between medical and psychological professionals in the management of PCa patients. This is crucial for improving the overall health related quality of life for patients. Full article

Background: Intentional occlusion of the internal iliac artery (IIA) during endovascular repair of aorto-iliac aneurysms may predispose patients to pelvic ischemic complications such as gluteal claudication, erectile dysfunction, and bowel ischemia. Iliac branch devices (IBDs) have been developed to preserve hypogastric perfusion. E-Liac (Artivion/Jotec) is one of the latest modular IBDs yet reports on mid-term performance are limited to small single-center cohorts with short follow-up. The CAMpania PugliA bRanch IliaC (CAMPARI) study is a multicenter investigation of E-Liac outcomes. Methods: A retrospective observational cohort study was conducted across five Italian vascular centers. All consecutive patients undergoing E-Liac implantation for aorto-iliac or isolated iliac aneurysms between January 2015 and December 2024 were identified from prospectively maintained registries. Inclusion criteria comprised elective or urgent endovascular repair of aorto-iliac aneurysms in which an adequate distal sealing zone was not available without covering the IIA and suitability for the E-Liac device according to its instructions for use (IFU). Patients with a life expectancy < 1 year or hostile anatomy incompatible with the IFU were excluded. The primary end point was freedom from branch instability (occlusion/stenosis, kinking, or detachment of the bridging stent). Secondary end points included freedom from any endoleak, freedom from device-related reintervention, freedom from gluteal claudication, aneurysm-related and all-cause mortality, acute renal failure, and sac regression > 5 mm. Results: A total of 69 consecutive patients (68 male, 1 female, median age 72.0 years) received 74 E-Liac devices, including 5 bilateral implantations. The mean infrarenal aortic diameter was 45 mm and the mean CIA diameter 34 mm; 14 patients (20.0%) had a concomitant IIA aneurysm (>20 mm). Concomitant fenestrated or branched aortic repair was performed in 23% of procedures. Two patients received a standalone IBD without implantation of a proximal aortic endograft. Technical success was achieved in 71/74 cases (96.0%); three failures occurred due to inability to catheterize the IIA. Distal landing was in the main IIA trunk in 58 cases and in the posterior branch in 13 cases. Over a median follow-up of 18 (6; 36) months, there were four branch instability events (5.4%): three occlusions and one bridging stent detachment. Seven patients (9.5%) developed endoleaks (one type Ib, two type II, two type IIIa, and two type IIIc). Five patients (6.8%) required reintervention, and five (6.8%) reported gluteal claudication. There were seven all-cause deaths (10%), none within 30 days or related to aneurysm rupture; causes included COVID-19 pneumonia, acute coronary syndrome, melanoma, gastric cancer, and stroke. No acute renal or respiratory failure occurred. Kaplan–Meier analysis showed 92% (95% CI 77–100) freedom from branch instability in the main-trunk group and 89% (60–100) in the posterior-branch group (log-rank p = 0.69). Freedom from any endoleak at 48 months was 87% (95% CI 75–95), and freedom from reintervention was 93% (95% CI 83–98). Conclusions: In this multicenter cohort, the E-Liac branched endograft demonstrated high technical success and favorable early–mid-term outcomes. Preservation of hypogastric perfusion using E-Liac was associated with low rates of branch instability, endoleak, and reintervention, with no 30-day mortality or aneurysm-related deaths. These findings support the safety and efficacy of E-Liac for aorto-iliac aneurysm management, although larger prospective studies with longer follow-up are needed. Full article

Obstructive sleep apnea (OSA) is a highly prevalent disorder with far-reaching systemic consequences. While its cardiometabolic and neurocognitive impacts are well established, growing evidence highlights OSA as a contributor to infertility in both men and women. The pathophysiological mechanisms include intermittent hypoxia, oxidative stress, systemic inflammation, and endocrine disruption, all of which can impair spermatogenesis, reduce semen quality, alter gonadal hormone secretion, and compromise ovarian function. Clinical studies consistently demonstrate associations between OSA and impaired semen parameters, reduced testosterone, and erectile dysfunction in men. In women, OSA is frequently observed in those with polycystic ovary syndrome, is associated with ovulatory dysfunction, and negatively affects in vitro fertilization outcomes, pregnancy rates, and miscarriage risk. Despite these findings, infertility is not systematically included in global burden estimates of OSA, leading to the underestimation of its true health and socioeconomic impact. Therapeutic strategies such as weight loss, continuous positive airway pressure, and integrative approaches show promise, though robust evidence from randomized trials is still lacking. Integrating sleep health into reproductive medicine may provide a cost-effective and equitable pathway to improve fertility outcomes worldwide. Full article

Background/Objectives: Sexual dysfunction (SD) and broader sexual health problems are common after neurological disorders, yet interventional evidence is fragmented across conditions and outcomes. This umbrella review mapped and appraised systematic review-level evidence on interventions targeting SD and sexual health in neurological populations and qualified conclusions using certainty of evidence. Methods: PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, EBSCOhost, and Scopus were searched from inception to 27 November 2025. Two reviewers screened records, extracted data, assessed review quality with AMSTAR 2, and rated certainty across intervention–outcome pairings using a GRADE-informed approach that integrated review confidence and primary-study risk-of-bias as reported by the source reviews. Results: Twenty-six systematic reviews were included. Overall confidence was frequently limited (17/26 critically low and 6/26 low), with only a small subset rated moderate or higher. Evidence was most coherent for phosphodiesterase type 5 (PDE5) inhibitors improving erectile function in men with spinal cord injury, whereas most other interventions and outcomes were supported by low or very low certainty. Women were represented in 16/26 reviews, yet validated female sexual function outcomes were synthesized in 6/26 reviews and relationship/couple outcomes in 3/26; furthermore, 10/26 reviews restricted inclusion to men, and no review synthesized pediatric intervention trials. Conclusions: Evidence supports PDE5 inhibitors for improving erectile function in men with spinal cord injury, while evidence for other interventions and sexual health domains remains limited. Methodological limitations highlight the need for more inclusive trials, broader standardized outcomes, and longer follow-up within neurorehabilitation pathways. Full article

Background: Sexual dysfunction (SD) affects up to two-thirds of individuals with early-onset Parkinson’s disease (PD), yet it remains underexplored in developing countries where stigma, depression, and treatment side effects may worsen its burden. This study investigated the magnitude and correlation of SD in early-onset PD. Methods: A cross-sectional study included 74 individuals with PD onset at ≤55 years of age. SD was assessed using the Medical Outcomes Study Sexual Functioning Scale, alongside interviews on sexual experiences after initiating PD medication. Prevalence was estimated descriptively, and Spearman’s correlation identified correlates of SD. Results: Half of participants reported SD, including lack of sexual interest (52.7%), difficulty relaxing or enjoying sex (52.7%), and impaired arousal (50%). Among men, 48% experienced erectile problems, while 44% of women reported difficulty achieving orgasm. After starting anti-Parkinson’s medication, 16% noted markedly reduced sexual desire, whereas nearly 10% reported increased desire. In men, SD correlated with levodopa dose (r = 0.411, p < 0.01). In women, SD correlated with stigma (r = 0.389, p < 0.05), depression (r = 0.529, p < 0.01), and anxiety (r = 0.629, p < 0.01). Conclusions: One in two individuals with early-onset PD experiences SD, independent of gender. Findings highlight the need for routine sexual health assessment and careful monitoring of treatment side effects. Interventions targeting stigma, depression, and anxiety are critical to improve sexual well-being in this population. Full article