ABSTRACT Patient comprehension of surgical information is often limited by medical jargon, health literacy barriers, and time constraints. Large language models (LLMs) such as ChatGPT‐5, Claude‐4, and Google AI search offer interactive context specific dialogue that may aid to overcome these limitations. To date, no study has assessed the ability of LLMs to provide patient education for hydrocelectomy, spermatocelectomy and vasovasostomy. The objective of this study was to assess the quality, readability, and understandability of LLM‐generated content for these procedures. The most common patient queries for each procedure were identified using Google Trends and educational materials from professional healthcare organisations. Questions were standardised into lay language and posed to ChatGPT‐5, Claude‐4 and Google AI search. Outputs were assessed using validated tools: DISCERN‐AI for quality, Global Quality Score (GQS) for quality and information flow, and PEMAT‐AI for understandability. Readability was assessed with Flesch Reading Ease and Flesch‐Kincaid Grade Level (FKGL). All models produced high‐quality responses (median DISCERN‐AI 13–14) and satisfactory understandability (median PEMAT 71%–86%). Median GQS was 4, indicating good information flow, though no responses achieved the maximum rating. Readability was consistently above population literacy levels for all three models (ChatGPT FKGL = 11.2, Claude FKGL = 14.2, Google FKGL = 12.3). When asked to assess the readability of their own outputs, the readability was overestimated by the LLMs in every instance. LLMs provide high quality, understandable and mostly accurate patient educational content on elective scrotal procedures for benign pathology. However, outputs are written at excessively high reading levels, potentially limiting accessibility. Future improvements in readability and fact‐checking are essential before widespread patient adoption.
ABSTRACT Erectile dysfunction (ED) is a prevalent and multifactorial disorder that substantially affects quality of life. Pathophysiology includes vascular, neurogenic, drug‐induced, and psychogenic causes, and frequently coexists with cardiometabolic disease. This review synthesizes contemporary evidence on ED diagnosis and management, spanning lifestyle optimization, pharmacologic therapy, device‐based approaches, regenerative modalities, and unique considerations in men treated for prostate cancer. A comprehensive, narrative literature review was conducted using PubMed and Embase to identify peer‐reviewed original studies and review articles published through September 2025. Relevant findings were synthesized to provide an updated overview of current diagnostic and therapeutic approaches and to highlight ongoing challenges and unmet clinical needs. We summarize the full range of contemporary therapies for erectile dysfunction, including lifestyle modification, comorbidity management, pharmacologic therapy, intraurethral agents, intracavernosal injections, vacuum erection devices (VED), penile prosthesis surgery, and postprostatectomy rehabilitation. Lifestyle optimization—particularly increased physical activity, smoking cessation, and glycemic control—remains foundational to both prevention and treatment. Phosphodiesterase type 5 inhibitors (PDE‐5i) continue to serve as first‐line therapy, with high efficacy, favorable safety, and emerging evidence of cardioprotective and renoprotective benefits. For men who do not respond to or cannot use PDE‐5i, effective alternatives include intracavernosal injections, VED, and penile prosthesis implantation. Regenerative therapies—such as low‐intensity extracorporeal shockwave therapy (LI‐ESWT), platelet‐rich plasma (PRP), and stem‐cell–based approaches—aim to restore endothelial and smooth muscle integrity, though evidence remains heterogeneous and long‐term randomized trials are needed. Combination strategies, including daily PDE‐5i therapy with testosterone replacement (in hypogonadal men), antioxidants, VED use, or LI‐ESWT, yield additive improvements without increased adverse events. Among prostate cancer survivors, ED remains common after radical prostatectomy and radiotherapy; early “prehabilitation” and structured rehabilitation with exercise, daily PDE‐5i, and VED use may enhance erectile recovery. ED management has evolved toward a comprehensive yet highly individualized model integrating lifestyle optimization, pharmacotherapy, and multimodal rehabilitation. Despite therapeutic advances, postprostate cancer ED remains a major unmet need. Future research should refine predictive models, optimize timing and combination of interventions, and explore regenerative and vascular restoration therapies to further enhance functional recovery and long‐term outcomes.
ABSTRACT Upper urinary tract stone disease is a common urological condition with high recurrence rates and a significant healthcare burden. Many patients initially present in community or primary care settings, where early assessment and triage influence patient safety, referral timing and subsequent urological management. Early evaluation should prioritise identification of obstructed infection, renal impairment and uncontrolled symptoms requiring urgent urological assessment. Ultrasonography is an appropriate first‐line imaging modality in many patients, although its limitations should be recognised to avoid delayed escalation. Non‐steroidal anti‐inflammatory drugs remain the cornerstone of acute pain management. Definitive urological interventions, including ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy, may be required when spontaneous passage is unlikely or complications develop. Long‐term management focuses on recurrence prevention through metabolic evaluation and targeted lifestyle or pharmacological interventions. A structured approach to early management and referral can improve patient safety and support timely urological care.
ABSTRACT Erectile dysfunction (ED) is a prevalent condition that can significantly affect men's sexual health and quality of life, and for which there are many well‐studied effective treatments. In spite of this, many individuals still seek out alternative therapies. In this review, we focus on summarizing the data that exists for the most common alternative therapies. We focus on over‐the‐counter medications, naturopathic supplements, extracorporeal shockwave therapy, and platelet‐rich plasma, as alternative treatments for ED that have either been shown not to work or have insufficient data to support their inclusion in mainstay treatment. As patients frequently seek out their own care options, it is important for physicians to familiarize themselves with these treatments and be prepared when counseling men seeking out treatments not recommended by Urology guidelines.
ABSTRACT Dapoxetine (on‐demand SSRI) and clomipramine (daily TCA) are commonly used for premature ejaculation (PE), yet direct comparative evidence remains limited and heterogeneous, particularly because dapoxetine is administered on‐demand while clomipramine requires daily dosing. To systematically review evidence comparing dapoxetine and clomipramine with emphasis on intravaginal ejaculatory latency time (IELT) and patient‐reported outcomes (PROMs). A narrative synthesis following PRISMA guidelines was conducted, evaluating randomized controlled trials assessing either drug. Owing to heterogeneity in dosing regimens, outcome definitions, and study designs, and to the absence of PROSPERO preregistration, findings were analyzed descriptively. Nineteen RCTs met inclusion criteria, including five studying dapoxetine (30–60 mg on‐demand) and 14 studying clomipramine (15–50 mg daily). Dapoxetine increased IELT 2.5–3.0‐fold, while clomipramine increased IELT 2.5–5.2‐fold. Improvements in PROMs were reported for both drugs. Only one RCT directly compared dapoxetine with clomipramine; all other trials compared each drug with placebo. The limited number of head‐to‐head trials and heterogeneity across studies restrict the strength of comparative conclusions. Both medications demonstrate meaningful improvements in IELT and patient satisfaction. Clomipramine shows greater short‐term efficacy, while dapoxetine offers superior tolerability and long‐term adherence. Given the heterogeneity in dosing regimens and limited direct comparative trials, treatment selection should be individualized. These findings align with EAU and ISSM guideline recommendations for PE management.
ABSTRACT Clinical trials drive evidence generation in men's health, yet temporal patterns in trial duration and completion remain poorly characterized. We examined relationships between trial duration, completion rates, and trial characteristics in men's health research registered over two decades. We conducted a cross‐sectional analysis of 5401 men's health clinical trials registered on ClinicalTrials.gov ClinicalTrials.gov between January 2005 and December 2024. Trials were identified using systematic Medical Subject Heading (MeSH) terms, including but not limited to hypogonadism, erectile dysfunction, infertility, benign prostatic hyperplasia, and prostate cancer. Primary outcomes were trial duration and completion status. Multivariable linear regression quantified associations between duration and calendar year, trial phase, funding source, and enrollment. Multivariable logistic regression evaluated predictors of trial completion. Median trial duration was 730 days (IQR: 365–1370). Trial duration decreased by 46 days annually ( β = −46.16 days/year; p < 0.01; R 2 = 0.06), representing approximately 920 fewer days over the study period. Completion rates declined concurrently, with 14% lower annual odds of completion (OR = 0.86/year; p < 0.01). Longer duration independently predicted non‐completion (OR = 0.89/day; p < 0.01). Phase 2 trials were 353 days longer than not applicable phase trials ( p < 0.01). NIHNIH‐funded‐funded trials exceeded industry‐funded trials by 1401 days ( p < 0.01), while network‐funded trials were 1333 days longer ( p < 0.01). Only 774 trials (14%) reported results despite regulatory requirements. Men's health trials demonstrate declining duration yet paradoxically decreasing completion rates over two decades. Funding source substantially influences trial timelines. Low results reporting limits evidence accessibility. These patterns may constrain the scope of feasible research innovation in men's health. Level of Evidence Level III.
ABSTRACT Digital platforms increasingly shape how male patients access health information, particularly in urology and men's health. While surgeons are active on social media, it remains unclear whether those who dominate online discourse reflect academic authority or simply digital visibility—and how this may influence patient perceptions and research priorities. To identify the most influential Australian surgeons on Twitter (X), examine the relationship between social media influence and academic impact, and explore the implications of digitally mediated visibility for men's health. Twitter influence scores for Royal Australasian College of Surgeons (RACS)‐affiliated surgeons were generated using the Right Relevance algorithm. The top 20 influencers were characterised by speciality, gender, location and academic impact (h‐index). Correlation between influence score and h‐index was assessed using Pearson's coefficient. Google Trends was analysed for key urological topics to describe how people are engaging with these topics online. Among the top 20 influencers, 75% were male, and 80% were based in metropolitan centres. Urologists were overrepresented (40%). Median h‐index was 10 (IQR = 21.5), with a moderate positive correlation between Twitter influence and academic impact ( r = 0.578, p = 0.007). Content was predominantly professional, including educational material and public health messaging. Increasing search interest was noted across key men's health‐related search terms on Google Trends. Highly visible surgeons on social media generally demonstrate academic credibility; however, digital influence represents a distinct and increasingly important form of authority in medicine and is likely to shape patient engagement and attention within men's health. In men's health, where patients increasingly engage with online content, this may skew attention toward conditions and topics that are more'visible' or engaging rather than those of greatest clinical need. Greater awareness of this evolving relationship between digital and academic authority is required to ensure that digital engagement enhances, rather than distorts, evidence‐based urological care and research priorities.
Prostate cancer is now the most frequently diagnosed cancer in UK men. Faster diagnostic pathways form a key component of the NHS Cancer Programme's strategic approach to improving patient outcomes. The Prostate cancer diagnostic pathway involves a number of stages which create potential areas of delay. We describe how data has been synthesised and used in the South West region through an innovation called the South West Prostate Dashboard to improve patient pathways.
This study aims to assess the awareness and knowledge level of lower urinary tract symptoms (LUTS) in male adults in primary care setting in Hong Kong and explore its relationship with the behavior of seeking medical help. This is a cross-sectional questionnaire-based study recruited male adults aged 40 years or older. Our primary outcome is the proportion of participants with adequate knowledge of LUTS. The secondary outcome is to explore the relationships between participants' awareness, knowledge of LUTS, and their medical-seeking behavior through correlation analysis and regression analysis. A total of 450 participants completed the questionnaire. Only 29.3% of the participants reported they had heard of LUTS before. Assessment of knowledge level also showed inadequate knowledge regarding the causes, preventive methods, and treatments. The proportion of adequate knowledge was 31.8%. Regression analysis showed both awareness (p = 0.002) and knowledge (p < 0.001) had a significant association with medical seeking behavior. Awareness and knowledge level about LUTS among male adults were insufficient. Both awareness and knowledge were significantly associated with medical-seeking behavior. Targeted education should be formulated to enhance patients' knowledge.
The high demand for cystoscopies performed for bladder cancer diagnosis or surveillance imposes a significant burden on regional centres with limited capacity. Cxbladder is a urinary biomarker test that estimates the likelihood of bladder cancer. International and Australian studies suggested its utility in excluding patients for bladder cancer, reducing unnecessary cystoscopies. We conducted a prospective observational study to validate the performance of Cxbladder Triage (CxT) and Cxbladder Monitor (CxM) in patients undergoing cystoscopies for haematuria workup or bladder cancer surveillance at a regional Australian centre. Patient demographics were retrieved from electronic records, and a single urine sample was collected and analysed. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. We also conducted a narrative review of the literature to examine the existing research efforts in Australia and New Zealand (ANZ) in the urinary-based diagnostic space for bladder cancer. One hundred and fifty-four patients were eligible for analysis. CxT demonstrated NPV 100% (95% CI 83.2-100) and sensitivity of 100% (95% CI 15.8-100) but low specificity (26%, 95% CI 16.6-37.2) and PPV (3.4%, 95% CI 0.4-11.7). Similarly, CxM had high NPV (96%, 95% CI 87.3-99.6), specificity (78.9%, 95% CI 67.0-87.9) and sensitivity (77.8%, 95% CI 40.0-97.2), but low PPV (33.3%, 95% CI 14.6-57.0). The narrative review showed that there have been extensive efforts within ANZ for the validation of Cxbladder, supporting its integration into clinical protocols. Cxbladder is useful to exclude bladder cancer as a cause of haematuria and reduces the need for diagnostic and surveillance cystoscopies. Future research should prioritise large multicentre trials, head-to-head biomarker comparisons and cost-effectiveness assessments to facilitate integration into standard clinical practice in ANZ.
Novoglan is a device that provides a non-surgical treatment of phimosis. It consists of a balloon placed under the foreskin, which the patient inflates in a controlled manner to stretch the foreskin and promote the generation of new skin cells. The balloon inflation had been originally controlled by an air plunger, which was later replaced by a bulb and a stop cock, while the balloon was changed from latex to medical-grade silicone. We conducted a post-marketing survey to assess patient-reported efficacy, usability, tolerability and safety of the Novoglan treatment and compare two generations of the device. Specifically designed questionnaires were emailed to 9700 Novoglan customers. Complete responses from 811 customers were de-identified and included in the analysis. The use of Novoglan with a bulb and a stop cock instead of an air plunger and a change of the balloon material produced an improvement in patient-reported efficacy from 85.0% to 93.5%. Usability has also improved, with the number of patients reporting difficulty in Novoglan use dropping from 13.8% to 6.7%. Similarly, the number of patients willing to recommend Novoglan treatment to other men increased from 92.2% to 98.1%. Neither group reported side effects that required cessation of the treatment or medical intervention, and 96.3% of all patients were able to tolerate the treatment. Of note, 97.7% reported that phimosis negatively impacts their mental well-being, and 88.8% reported that Novoglan had improved their mental health. The Novoglan post-marketing study revealed improvement in patient-reported efficacy, usability, tolerability and overall satisfaction with the introduction of the bulb and stop cock into the Novoglan device. It demonstrated the exceptional safety of the Novoglan treatment with no significant side effects reported and an improvement in the mental well-being of almost 90% of patients. These findings highlight the role of Novoglan treatment as an effective and safe non-surgical management of phimosis.
Persisting small renal stone fragments remain a challenge after conventional renal stone treatment (ESWL or endoscopic treatment). Physical vibration therapy and patient inversion therapy are new techniques developed with the aim of increasing the stone-free rate (SFR). This study aims to evaluate the efficacy and safety of physical therapy and mechanical percussion in improving SFR after conventional stone surgery. A systematic review meta-analysis was performed according to the Cochrane Handbook and registered in PROSPERO (CRD42021232954). PubMed, Web of Science, and Scopus databases were searched for manuscripts considering adjunctive stone treatment methods following endoscopic surgery or shock wave lithotripsy, published between 2018 and 2024. Additional inclusion criteria encompassed randomized controlled trials, cohort studies, and case-control studies published in English. Duplicate studies or studies that did not meet the inclusion criteria were excluded. Full manuscripts were reviewed for clinical data. OpenMeta (analyst) was used to perform statistical analysis, and the ROBINS-I tool was used for risk of bias assessment. Six studies comprising 1026 participants were included. Our study showed that adjuvant therapy (EPVL or PDI) after stone surgery (ESWL or RIRS) significantly increases SFR at 1 week (OR = 0.60, p < 0.001), 2 weeks (OR = 0.689, p < 0.001), and at 4 weeks (OR = 0.786, p < 0.001). Complications did not differ between treatment arms and control groups. The overall risk of bias among studies was low. Adjuvant therapy has been shown to be an effective tool in increasing SFR post-conventional stone surgery. Further research is necessary to create standardized treatment protocols.
Paid parental leave is a key factor in promoting gender equity, supporting child development, and fostering paternal involvement. Despite its benefits, the United States (US) lacks a national paid leave policy, with substantial disparities in access and implementation across industries and institutions. To characterize the availability and equity of paid paternity leave policies across US private-sector companies and academic institutions affiliated with Obstetrics and Gynecology (OB/GYN) residency programs, and to examine disparities by industry. We analyzed publicly reported leave policies using two sources: crowd-sourced data from US private-sector companies via theSkimm and publicly available policies OB/GYN residency-affiliated institutions listed in the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database Access (FREIDA) database. Employers were included if they specified the duration of paid parental leave, excluding those with unlimited vacation, missing duration, or no paternity leave data. Employers were grouped by North American Industry Classification System (NAICS) codes. We compared average leave durations and rates of leave equity. Among 565 private-sector companies, 81.9% offered paid paternity leave. After exclusion, only 45.8% offered equal maternity and paternity leave ( n = 498). Fathers received 9.7 weeks on average versus 15.5 for mothers ( p < 0.001). Among 240 OB/GYN-affiliated institutions, 75.7% of those offering paid leave provided equal durations, though paternity leave was shorter than that in the private sector (6.1 vs. 9.7 weeks; p < 0.001). Academic institutions may prioritize equity more than private employers, but offer less generous leave overall. National standards are needed to reduce disparities.
Phimosis is common, characterised by the inability to retract the prepuce. Whilst circumcision remains the conventional surgical treatment, it is a radical and risk-associated procedure that may not align with patients' cultural and religious beliefs. There has been a shift towards conservative therapies and surgical techniques that preserve the prepuce. This narrative review aims to provide a comprehensive synthesis of prepuce-preserving treatment options for phimosis. A structured literature search utilised key search terms relevant to the condition (e.g., ‘phimosis’, ‘non-retractile foreskin’) and its management (e.g., ‘treatment’, ‘topical corticosteroids’, ‘preputioplasty’). Identified articles underwent manual review before inclusion. An array of alternatives to circumcision is available in the treatment of phimosis. Gentle daily foreskin retraction combined with topical corticosteroid therapy offers an accessible early intervention. Platelet-rich plasma therapy represents a novel pharmacological technique that demonstrates promise in early research. Dilatation devices such as Novoglan and Phimostop allow for self-administered, community-based treatment; both devices have shown encouraging outcomes, including high patient satisfaction and ease of use. In cases refractory or not amenable to conservative therapy, preputioplasty serves as a viable surgical option, encompassing various techniques that, unlike circumcision, aim to preserve the cosmetic and protective functions of the foreskin. A growing array of prepuce-preserving alternatives to circumcision is available, ranging from conservative therapies to innovative surgical techniques. Raising awareness and improving understanding of these options amongst healthcare providers and patients is crucial to the delivery of patient-centred care.
Testosterone replacement therapy has evolved significantly in recent years, driven by high-quality clinical evidence and expanded treatment options. The 2023 TRAVERSE trial provided definitive cardiovascular safety data, leading to FDA removal of black box warnings in 2025 and altering the clinical approach to testosterone therapy. Concurrent developments in delivery methods—including subcutaneous administration and oral formulations—have improved patient convenience and adherence. Modern diagnostic approaches incorporate advanced biomarkers and genetic testing to enable more individualized treatment selection, while contemporary monitoring protocols utilize risk-stratified surveillance. Special populations, including men with cardiovascular disease, fertility concerns, and prostate cancer history, can now be evaluated using evidence-based approaches that weigh potential benefits against safety considerations. This review examines the current state of testosterone replacement therapy in 2025, including diagnostic approaches, treatment formulations, monitoring strategies, and clinical considerations for specific patient populations. The shift from categorical contraindications to individualized assessment reflects the growing evidence base supporting testosterone therapy when appropriately indicated and monitored.
This study aimed to explore UK healthcare professionals' perspectives on support for male breast cancer patients and their informal carers, and to identify avenues for improvement. UK-based HCPs involved in the care of breast cancer patients (men and/or women) were invited to complete an online survey about their experiences of explaining diagnoses and treatment, perceptions of current support and areas for improvement. Data were analysed using descriptive statistics and qualitative content analysis. Respondents (N = 62) reported providing a variety of resources and sources of practical and emotional support, but 81% found existing resources inappropriate and insufficient. Recommendations included increased availability of male-specific breast cancer information and support, and training for healthcare professionals working in this field. Increased psychosocial support and enhanced, gender-appropriate resources are crucial for supporting male breast cancer patients and their informal carers and reducing isolation. Healthcare professionals need access to training on this topic.
Cigarette smoking remains a common modifiable lifestyle risk factor for male infertility, yet the exact mechanisms linking smoking to overall fertility decline are not fully understood. This study investigates how smoking affects sperm quality deterioration and examines the potential role of hormonal pathways in mediating these effects. Robust causal approaches have been utilized to measure both the overall impact of smoking and its hormonal mediation on semen parameters. Additionally, a unidimensional Sperm Quality Index (SQI) has been developed and validated internally, while latent reproductive phenotypes have been analyzed through unsupervised clustering techniques. This observational study involved 104 infertile men, with 52 smokers and 52 nonsmokers. Inverse-probability-of-treatment weighting (IPTW) and augmented IPTW (AIPW) were used to balance 21 baseline covariates. Parallel mediation analysis evaluated four pituitary-gonadal hormones-follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone-as mediators of smoking's impact on five key semen parameters: concentration, total count, progressive motility, morphology, and live sperm percentage. Principal component analysis (PCA) was used to create a PCA-based SQI by combining nine logarithmically transformed, z-standardized variables. The mediation analysis was also repeated using the SQI. K-means clustering, using the gap statistic, identified four latent semen-hormone phenotypes. After IPTW, smoking was associated with standardized AIPW average treatment effects (ATEs) of -0.29 to -0.66 standard deviation (SD) across semen parameters (e.g., live sperm % ATE = -0.67, 95% confidence interval (CI) -1.01 to -0.33; morphology ATE = -0.40, 95% CI -0.75 to -0.05). Parallel mediation indicated LH as the principal mediator, explaining 40%-63% of smoking's total effect on individual outcomes. The PCA-derived SQI explained 65% of semen variance, and smoking's ATE on SQI was -0.44 SD (95% CI -0.80 to -0.07), with 66% mediated via hormones (suppression effect). Clustering revealed four phenotypes: (1) normozoospermic, (2) subclinical endocrinal disruption, (3) intermediate, and (4) severely impaired (high LH, low SQI), with smokers predominating cluster 4 (85% smokers vs. 15% nonsmokers). Cigarette smoking primarily impacts semen quality by disrupting endocrine hormones. The PCA-based SQI offers a more sensitive overall measure of impairment compared to individual parameters and can serve as a straightforward biomarker for evaluating sperm quality, aiding clinicians in diagnosing male infertility. The characterized phenotypes suggest potential for personalized treatment strategies. These findings emphasize the importance of quitting smoking for fertility treatment and indicate that pituitary-gonadal hormones could be promising targets for therapy.
