Current Opinion in Urology最新文献

{"title":"Management strategies for ICSI cases with extremely poor sperm parameters.","authors":"Philip Xie, Stephanie Cheung, Lily Ng, Angela De Jesus, Zev Rosenwaks, Gianpiero D Palermo","doi":"10.1097/MOU.0000000000001437","DOIUrl":"10.1097/MOU.0000000000001437","url":null,"abstract":"<p><strong>Purpose of review: </strong>Intracytoplasmic sperm injection (ICSI) transformed the treatment of severe male factor infertility by reducing the sperm-cell-to-oocyte ratio to one-to-one. This review summarizes current approaches to identify and utilize rare spermatozoa in men with cryptozoospermia, virtual azoospermia, and nonobstructive azoospermia (NOA): assistive technologies for extended sperm search, approaches to rescue dysfunctional spermatozoa, and novel biomarkers to predict residual spermatogenesis.</p><p><strong>Recent findings: </strong>Extended sperm search protocols involving high-speed centrifugation, high-magnification microscopy, and viability assessments improve sperm recovery in men with cryptozoospermia, virtual azoospermia, and NOA. Microsurgical testicular sperm extraction (microTESE) remains the optimal surgical method for sperm retrieval in NOA men. Sperm treatments, including phosphodiesterase inhibitors to enhance sperm motility and assisted oocyte activation, improve viable sperm identification and fertilization competence, respectively. artificial intelligence-driven imaging can identify extremely rare spermatozoa, while genomic, transcriptomic, and proteomic biomarkers noninvasively predict residual spermatogenesis in NOA patients.</p><p><strong>Summary: </strong>ICSI has enabled the identification of a single spermatozoon, allowing men with compromised spermatogenesis to father offspring. Beyond sperm identification, rescuing fertilization competence of compromised sperm is crucial. Integrating molecular diagnostics may improve prognostic accuracy and clinical counseling, while emerging technologies like neogametogenesis may offer reproductive options for men with spermatogenic arrest or germ cell aplasia.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"674-681"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of erectile dysfunction in phosphodiesterase type 5 inhibitor nonresponders.","authors":"Rodrigo Barros, Gabriel Moreira Crelier, Luciano Alves Favorito","doi":"10.1097/MOU.0000000000001438","DOIUrl":"10.1097/MOU.0000000000001438","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite the effective use of phosphodiesterase type-5 inhibitors, a considerable number of patients fail initial attempts to manage erectile dysfunction with these medications. We reviewed the literature describing recent advances and future directions, and propose new regimens to manage nonresponders.</p><p><strong>Recent findings: </strong>Patient education, psychological interventions, lifestyle changes and treatment of comorbidities are associated with improved erectile function. The administration of testosterone replacement combined with phosphodiesterase type-5 inhibitors promotes beneficial effects on erectile function in hypogonadal men. Combination of two different phosphodiesterase type-5 inhibitors at the same time is a promising approach, especially in individuals with more severe forms of erectile dysfunction, without increasing the incidence of adverse events. Although intracavernosal injection and penile prosthesis implantation are traditional and established therapeutic options to restore erectile function in refractory cases. Recent advances in medicine have expanded the therapeutic panorama, with emerging regenerative approaches, showing promising potential to restore erectile function.</p><p><strong>Summary: </strong>The choice of the best strategies should be individualized according to the preferences of the patient and his sexual partner based on the advantages and disadvantages of the various options. Therefore, shared decision-making with the patient is strongly encouraged.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"607-615"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric andrology: bridging pediatric urology and reproductive medicine.","authors":"Koji Shiraishi","doi":"10.1097/MOU.0000000000001422","DOIUrl":"10.1097/MOU.0000000000001422","url":null,"abstract":"<p><strong>Purpose of review: </strong>Andrological disorders, including male infertility, hypogonadism, and sexual dysfunction, are often managed in adulthood despite their origins in early life. This review proposes the emerging concept of 'pediatric andrology', which integrates pediatric urology, endocrinology, and reproductive medicine, and aims to highlight its clinical significance from a life-course perspective.</p><p><strong>Recent findings: </strong>Growing evidence suggests that common andrological conditions such as varicocele, cryptorchidism, and Klinefelter syndrome originate in childhood and have long-term implications for fertility and hormonal function. Advances in microsurgical techniques and assisted reproductive technologies, including microdissection testicular sperm extraction (micro-TESE), have improved reproductive outcomes even in severe cases. In parallel, recent guidelines emphasize the importance of early diagnosis, appropriate timing of intervention, and structured transition to adult care. However, controversies remain regarding optimal management strategies, timing of surgical intervention, and fertility preservation, particularly in adolescents. Environmental and lifestyle factors may also contribute to future reproductive health, although evidence is still evolving.</p><p><strong>Summary: </strong>Pediatric andrology represents a novel interdisciplinary field that bridges pediatric urology and adult reproductive medicine. A life-course approach is essential to better understand the pathophysiology of andrological disorders and to optimize long-term outcomes. Establishing structured transition care and promoting collaboration across specialties will be critical for advancing this field and improving male reproductive health.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"616-622"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing outcomes of micro-TESE for men with nonobstructive azoospermia.","authors":"Duc H Le, Khanh D N Nguyen, Tan V Le","doi":"10.1097/MOU.0000000000001436","DOIUrl":"10.1097/MOU.0000000000001436","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize contemporary, high-quality evidence on optimizing microdissection testicular sperm extraction (micro-TESE) outcomes for men with nonobstructive azoospermia (NOA). This review transitions the focus from plateaued baseline retrieval rates to a precision-based, surgeon-centric clinical pathway encompassing comprehensive preoperative, intraoperative, and laboratory domains.</p><p><strong>Recent findings: </strong>Preoperative risk stratification is evolving beyond isolated clinical markers. Emerging multivariable nomograms and investigational liquid biopsies, such as seminal extracellular vesicle RNAs, offer refined predictive capabilities. Current evidence strongly supports selective varicocele repair prior to micro-TESE to significantly improve sperm retrieval and clinical pregnancy odds in specific cohorts. Conversely, hormonal optimization demands a targeted, phenotype-directed approach, emphasizing aromatase inhibitors for patients with a low testosterone-to-estradiol ratio, while the routine empirical use of clomiphene citrate remains contentious. Intraoperatively, advanced mapping modalities, including contrast-enhanced ultrasound and robotic-assisted platforms, provide high-resolution navigation. However, the systematic identification of dilated seminiferous tubules under high optical magnification, coupled with real-time embryological feedback, remains the definitive cornerstone of surgical success. Furthermore, the adjunctive use of artificial intelligence in embryological processing demonstrates significant potential in accelerating rare sperm detection.</p><p><strong>Summary: </strong>Surpassing the current ceiling of micro-TESE success requires a highly individualized, multidisciplinary strategy. This encompasses rigorous genetic and endocrine profiling, phenotype-specific preoperative optimization, and meticulous, tissue-sparing microsurgical techniques. As noninvasive biomarkers and artificial intelligence transition into clinical maturity, their integration will further refine patient selection and intraoperative decision-making, ultimately elevating the standard of care for this severe cohort of male infertility.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"647-652"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The FSH reset hypothesis: optimizing spermatogenesis in azoospermia.","authors":"Nicholas Bedi, Ranjith Ramasamy","doi":"10.1097/MOU.0000000000001432","DOIUrl":"10.1097/MOU.0000000000001432","url":null,"abstract":"<p><strong>Purpose of review: </strong>Elevated follicle-stimulating hormone (FSH) in primary hypogonadism is usually read as maximal but failing testicular stimulation, and affected men are often considered poor candidates for hormonal therapy. This is a hypothesis-generating narrative review rather than an evidence-based treatment recommendation. It re-examines that assumption and asks whether FSH bioactivity, rather than concentration alone, might shape the testicular response.</p><p><strong>Recent findings: </strong>Circulating FSH is a mixture of glycosylation-dependent isoforms that differ in receptor-binding efficiency in experimental systems. Chronic gonadotropin excess can downregulate and desensitize the FSH receptor in animal and in vitro models. In principle, these mechanisms could combine to produce a state of functional FSH resistance, in which immunoreactive FSH is high while the effective signal in the testes is weaker. FSH suppression-associated rises in inhibin B, contemporary staged conditioning protocols, and stratification of hypergonadotropic men under the APHRODITE criteria are consistent with a strategy of temporary suppression before stimulation.</p><p><strong>Summary: </strong>We outline the FSH reset hypothesis, in which a finite period of pituitary suppression reduces inefficient endogenous hormone and may allow receptor recovery before controlled recombinant FSH. We then present a stepwise treatment algorithm as a model for future investigation in selected men with spermatogenic failure. The hypothesis is speculative and remains unproven in prospective trials.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"630-636"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of antioxidants in idiopathic male factor infertility.","authors":"Jio Jerome Co, Monroe Orlina, Ryzee Raychelle Buban, Marlon Martinez","doi":"10.1097/MOU.0000000000001442","DOIUrl":"10.1097/MOU.0000000000001442","url":null,"abstract":"<p><strong>Purpose of review: </strong>Idiopathic male factor infertility remains a major reproductive health concern, presenting with abnormal semen parameters despite no identifiable anatomical, hormonal, genetic, infectious, or endocrine cause. Oxidative stress is recognized as a central mechanism, as excessive reactive oxygen species can impair sperm concentration, motility, morphology, mitochondrial function, and DNA integrity. This review evaluates antioxidant therapy, mainly, in idiopathic male factor infertility.</p><p><strong>Recent findings: </strong>Current evidence suggests that selected antioxidants may improve several semen parameters. However, improvements in semen quality do not consistently translate into higher pregnancy or live birth rates. Evidence remains limited by small sample sizes, heterogeneous formulations, variable dosing, inconsistent outcome reporting, and inadequate oxidative stress testing.</p><p><strong>Summary: </strong>Antioxidants may be useful as targeted adjunctive therapy for selected men with idiopathic abnormal semen parameters, suspected oxidative stress, or elevated sperm DNA fragmentation. However, routine empirical use in all infertile men is not supported by evidence given the heterogeneity of formulations and limited comparative evidence. Treatment should be individualized, time-limited, and guided by oxidative stress assessment when available. Importantly, supplementation should not delay surgical intervention or assisted reproductive technologies when indicated. Future studies should prioritize standardized protocols and live birth outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"660-669"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-based techniques in sperm detection.","authors":"Laura C Gemmell, Hemant Suryawanshi, Zev Williams","doi":"10.1097/MOU.0000000000001430","DOIUrl":"10.1097/MOU.0000000000001430","url":null,"abstract":"<p><strong>Purpose of review: </strong>Artificial intelligence (AI) is emerging as a promising tool for sperm detection in men with azoospermia and cryptozoospermia, conditions in which rare spermatozoa can be difficult and time-consuming to identify. This review summarizes recent advances in AI-assisted sperm detection and their potential clinical applications.</p><p><strong>Recent findings: </strong>Recent studies demonstrate that deep learning-based systems can improve the speed and sensitivity of sperm detection in both testicular tissue and ejaculate samples. AI-assisted image analysis has reduced search times and improved detection rates compared with conventional manual evaluation. Emerging technologies include augmented reality platforms that support embryologists during sperm searches and AI-integrated microfluidic systems capable of sperm detection and isolation. Early clinical data suggest these approaches may enable sperm recovery in patients previously considered sperm-negative by conventional methods.</p><p><strong>Summary: </strong>AI-assisted sperm detection has the potential to improve efficiency, reproducibility, and access to fertility treatment for men with severe male factor infertility. Although further validation is required, ongoing advances in AI, imaging, and microfluidics may transform the diagnosis and management of azoospermia and cryptozoospermia.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"682-686"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative men's health: testosterone, metabolic fitness, and preventive urology.","authors":"Marlon Martinez, Ranjith Ramasamy","doi":"10.1097/MOU.0000000000001444","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001444","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"36 6","pages":"605-606"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolutions in the management of severe male infertility.","authors":"Peter N Schlegel","doi":"10.1097/MOU.0000000000001447","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001447","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"36 6","pages":"670-673"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isotretinoin for the treatment of severe male infertility.","authors":"John K Amory, Molly Jessup, Paul J Turek","doi":"10.1097/MOU.0000000000001429","DOIUrl":"10.1097/MOU.0000000000001429","url":null,"abstract":"<p><strong>Purpose of review: </strong>To achieve pregnancy, men with azoospermia must currently undergo a testicular procedure to retrieve sperm for intracytoplasmic sperm injection (ICSI). However, sperm are successfully retrieved only ~50% of the time. Recently, isotretinoin administration has been investigated as a means of increasing sperm production in azoospermic men. This review explains the rationale for isotretinoin use and will update readers on the results from early studies of isotretinoin treatment of male infertility.</p><p><strong>Recent findings: </strong>Pilot studies suggest that isotretinoin treatment for 3-6 months may improve sperm production to the point of reliable ejaculated sperm in up to one quarter of men with azoospermia. Notably, response rates differ by histological sub-type, with 25-40% of men with maturation arrest exhibiting improvement, while men with Sertoli-cell only syndrome do not appear to benefit. A recent case series found that in men with cryptozoospermia, sperm production can be stimulated to levels that allow for ICSI using ejaculated samples in about half of men, thus obviating the need for testicular sperm retrieval procedures.</p><p><strong>Summary: </strong>Isotretinoin therapy may improve sperm production in a subset of men with severe infertility. A fuller understanding of which men will benefit from isotretinoin will require larger studies.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"701-706"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}