Context: Erectile dysfunction (ED) is a common sexual disorder. In France, recent evidence-based guidelines are lacking. Aim: To provide practice guidelines on ED therapeutic management. Evidence acquisition: Publications indexed in PubMed/Medline1 between January 1999 and October 2023, were reviewed. For each clinical question, a level of evidence was attributed to the conclusions. These conclusions and the working group arguments were used to develop and grade (A-C) the recommendations. Recommendations: ED management must be personalized. Phosphodiesterase 5 inhibitors (PDE5I) are recommended as first-line treatment (A). In patients with severe ED, a combination of PDE5I may be proposed as first- or second- line treatment (Expert Agreement, EA). Extra-cavernous or intra-urethral injections of alprostadil maybe offered as first-line alternative to PDE5I or as second-line treatment (B). In case of unsatisfactory response to PDE5I or alprostadil alone, the combination of a PDE5I with intra-cavernosal or intra-urethral alprostadil may be proposed (EA). Vacuum therapy can be offered to all patients (B). Low-intensity extracorporeal shockwave therapy may be proposed to patients with mild or moderate ED, alone or in combination with PDE5I (B). Penile implants are indicated for patients with ED who are refractory or intolerant to pharmacological or mechanical treatments, or if they wish a permanent solution (B). Revascularization surgery may be offered to patients without comorbidities following pelvic trauma and ED with isolated arterial insufficiency (B). In addition to pharmaceutical, mechanical and/or surgical treatments, it is suggested to always consider educational interventions and counseling, lifestyle modifications and management of co-morbidities and curable causes. (c) 2024 Published by Elsevier Masson SAS.

Le post-orgasmic illness syndrome (POIS) ou malaise post-orgasmique est un trouble rare contemporain de l’orgasme ou de l’éjaculation chez l’homme. Il se définit principalement par une chronologie spécifique (apparaissant constamment dans les minutes suivant l’orgasme ou l’éjaculation, toujours de même intensité et régressant spontanément) et des 7 types de symptômes différents pouvant s’additionner. Ce trouble a des répercussions sur la vie sexuelle des patients, la qualité de vie générale et des répercussions sur le travail. L’étiologie et le traitement restent aujourd’hui encore sujet à discussion.

Introduction 5 % des hommes demanderont une vaso-vasostomie après vasectomie. Nous avons mené une étude clinique observationnelle en trois étapes avec un groupe d’experts afin de développer un score de risque de regret de vasectomie. Méthodes Focus group d’experts : interview d’experts impliqués dans la santé masculine qui ont proposé d’éventuels facteurs de risque de regret pour la vasectomie. Étude clinique : les facteurs théoriques ont été étudiés dans la population belge ayant subi une vasectomie dans les 15ans. Consensus international Delphi : système de notation établi à la lumière de l’étude clinique présentée aux experts. Résultats Focus group composé de 52 experts internationaux : identification de 17 raisons possibles de regret de la vasectomie. Étude clinique : cinq cent quatre-vingt-quatorze patients ont répondu à l’étude. Identification de cinq critères significatifs : patient jeune (<35ans), impulsif, avec un faible niveau d’éducation, ne comprenant pas le caractère irréversible de la vasectomie, utilisant idéalement une contraception féminine ou pas de contraception du tout. Analyse multivariée : mise en place d’une analyse multivariée avec quatre facteurs de risque, considérant le caractère irréversible de la procédure et l’absence de désir d’enfant dans le futur comme une « condition sine qua non ». Parmi ces facteurs, trois sont significatifs - exclusion du niveau d’éducation. Élaboration d’un algorithme de décision pour cibler les patients ayant besoin d’informations sur la cryoconservation de sperme avant la vasectomie avec les 3 facteurs (score de risque≥4) ou un délai de réflexion supplémentaire (score de risque≥7). Consensus Delphi d’experts : le système de notation a été accepté à 86,7 % par experts qui étaient tout à fait d’accord et par 6,7 % qui étaient faiblement d’accord. Régression logistique : sensibilité du modèle de 0,98 et spécificité de 0,53. Conclusion Élaboration d’un algorithme de décision avec 3 facteurs et 2 conditions sine qua non pour cibler les patients ayant besoin d’informations sur la cryoconservation de sperme avant la vasectomie ou d’un délai supplémentaire de réflexion (Fig. 1, Fig. 2).

Background. - Among couples consulting for infertility, there is a male component, either alone or associated with a female aetiology in around one in 2 cases.Material and methods. - Bibliographic search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2023.Results. - The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound, +/- an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration <= 10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration <= 1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained.Conclusion. - This review complements and updates the AFU/SALF 2021 recommendations.(c) 2023 Published by Elsevier Masson SAS.

Dans 50 % des cas, l'infertilité est partiellement ou totalement d'origine masculine. L'uro/andrologue joue donc un rôle central dans la prise en charge des couples consultant pour une assistance médicale à la procréation (AMP). Cette étude vise à évaluer sur les sites internet des centres d'AMP en France : l'information sur les facteurs masculins d'infertilité, la présence d'andrologues et comment le(s) contacter. À partir du site de la société savante BLEFCO, nous avons recensé en février 2023, 99 centres d'AMP que nous avons analysés. Les centres ne disposant pas de site internet ont été exclus. Les caractéristiques de chaque centre (nombre de médecins par spécialités, statut académique, public ou privé, localisation) ont été relevées. Un examinateur a évalué la présence et la description des termes liés à l'infertilité masculine (analyse du sperme, azoospermie, oligospermie, caryotype, micro-délétion du chromosome Y, hypogonadisme, varicocèle, traitement médical, extraction chirurgicale de spermatozoïdes), ainsi que la présence d'un uro/andrologue et ses informations de contact. Parmi les 99 centres d'AMP, seuls 5 n'avaient pas de site internet destiné aux patients. Vingt-six avaient une valence universitaire. Quarante deux établissements étaient publics, et 57 privés. Seuls 20 (21,3 %) abordaient la fertilité masculine, dont 16 (17,0 %) les étiologies de l'infertilité masculine et 17 (18,1 %) les traitements andrologiques. Les biopsies testiculaires ou les prélèvements épididymaires étaient mentionnés sur 13 sites (13,8 %), la vaso-vasostomie sur 2 sites (2,1 %), et les traitements de la varicocèle sur 7 sites (7,4 %). Parmi les 70 sites mentionnant la composition de leur équipe, seuls 24 (34,3 %) faisaient référence à un urologue sur leur site internet. Le nombre d'urologue dans ces centres était 1 dans 75 % des cas. Les centres disposant d'un urologue étaient plus susceptibles de délivrer une information sur les pathologies andrologiques sur leur site (Fig. 1). L'urologue est rarement mentionné sur les sites des centres d'AMP. De plus, les informations spécifiques sur les facteurs de risque d'infertilité masculine et les traitements andrologiques y sont rarement mentionnés. Il est essentiel de renforcer le lien avec les acteurs de l'AMP et de sensibiliser les patients réalisant un parcours d'AMP sur les bénéfices de la prise en charge andrologique.

Le rôle des infections urogénitales dans l'infertilité masculine fait depuis longtemps l'objet d'un débat. Une recherche bibliographique limitée à la littérature en anglais chez l'homme publiée avant 5/2023 a permis après analyse de sélectionner 189 articles. L'infertilité masculine est souvent d'étiologie multifactorielle, et il est important pour optimiser le pronostic de prendre en charge tous les facteurs correctibles, dont les causes infectieuses, qui représentent l'une des plus fréquentes étiologies. Les agents infectieux en cause dans les infections urogénitales sont le plus souvent bactériens ou viraux, plus rarement parasitaires. Ils peuvent infecter les voies séminales, les glandes accessoires masculines et/ou les testicules et aboutissent le plus souvent à une inflammation et à une augmentation du stress oxydant. Ces infections diminuent la fertilité masculine, notamment en altérant les paramètres du spermogramme et en augmentant la fragmentation de l'ADN du spermatozoïde. Pour ces raisons, la recherche d'une infection urogénitale doit être systématique avec anamnèse et examen clinique minutieux, échographie et examens bactériologiques systématiques et orientés par la clinique. Un traitement étiologique pourra être proposé en fonction du tableau et du germe en cause. Cette revue devrait aider l'urologue à établir un diagnostic précis de la forme et de l'extension de l'infection, et lui permettre de définir une stratégie thérapeutique appropriée, adaptée au patient, afin d'obtenir les meilleures chances d'amélioration de la fertilité masculine. The role of urogenital infections in male infertility has long been the subject of debate. A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles. Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved. This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.

La varicocèle est la plus fréquente cause corrigible d’infertilité masculine. Elle a fait l’objet de recommandations récentes du Comité d’andrologie et de médecine sexuelle (CAMS) de l’Association française d’urologie (AFU). Depuis, la littérature a apporté des éléments supplémentaires. Cette revue réévaluera de manière exhaustive les indications actuelles du traitement des varicocèles, et reviendra sur les questions contemporaines au regard des avancées actuelles. Réactualisation de la recherche bibliographique effectuée dans le cadre des recommandations du CAMS sur la période entre 2020 et 2023. La varicocélectomie microchirurgicale sub-inguinale demeure le traitement chirurgical de référence pour les hommes infertiles présentant une varicocèle clinique et des paramètres spermatiques anormaux. Elle offre des taux de récidive inférieurs à 4 %. Elle améliore significativement les taux de naissances vivantes et de grossesse à la fois naturellement et par fécondation in vitro, ainsi que la numération, la mobilité totale et progressive, la morphologie et le taux de fragmentation de l’ADN des spermatozoïdes. Au total, elle modifie la stratégie en aide médicale à la procréation (AMP) dans environ un cas sur deux. Le grade et la bilatéralité de la varicocèle sont prédictifs de l’amélioration des paramètres spermatiques et du taux de grossesse. Il n’est pas recommandé de traiter les varicocèles infracliniques. Les complications sont rares, notamment les hydrocèles (0,5 %), les atrophies testiculaires unilatérales par atteinte artérielle (1/1000), les hématomes, retards de cicatrisation, et douleurs postopératoires. L’embolisation rétrograde est une alternative à la chirurgie. L’urologue doit chaque fois que possible présenter et discuter avec l’équipe d’AMP et le patient les possibilités de traitement d’une varicocèle dans une approche personnalisée. Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d’urologie (AFU) Comité d’andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances. Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.

BACKGROUND:Since the 1970s, there has been a quantitative and qualitative decline in sperm parameters. The main hypothesis to explain such a rapid evolution is the involvement of environmental and behavioral phenomena. METHODS:A bibliographic search limited to English and French literature in men published before 7/2023 was carried out on the links between fertility and pollution, xenobiotics, tobacco, narcotics, cannabis, alcohol, weight, sport, sedentary lifestyle, sleep and anabolics. RESULTS:Profound changes in lifestyle have occurred over the past 50 years: reduced sleep time, sedentary lifestyle, dietary changes, tobacco consumption, use of narcotics and anabolics. These changes have a proven impact on spermogram parameters, and should be corrected in an effort to optimize reproductive health. Other environmental parameters: pollution, exposure to heavy metals, exposure to xenobiotics, phthalates and pesticides… will be more difficult to exclude from patients' daily lives, but deserve to be taken more into account. CONCLUSION:This review should help the urologist to assess and counsel patients in order to improve their reproductive health. These factors should be routinely investigated in infertile men.

Parmi les couples consultant pour infécondité, une part masculine est présente, seule ou associée à une étiologie féminine dans environ un cas sur 2. Recherche bibliographique dans PubMed en utilisant les mots-clés « male infertility », « diagnosis », « management » et « evaluation » limitée aux articles cliniques en anglais et en français antérieurs au 1/01/2023. L'AFU recommande : (1) une anamnèse complète avec : antécédents familiaux, antécédents du patient ayant un impact sur sa fertilité, habitudes de vie (toxiques), traitements, symptômes, dysfonctions sexuelles ; (2) un examen physique avec : IMC, signes d'hypogonadisme, caractères sexuels secondaires, examen scrotal (volume et consistance des testicules, canaux déférents, nodules épididymaires ou testiculaires, présence d'une varicocèle) ; (3) Deux spermogrammes, si anomalie au premier ; (4) une échographie scrotale systématique, ± une échographie endorectale selon la clinique ; (5) un bilan hormonal (testostérone, FSH ; si la testostérone est basse : dosage de la LH pour différencier un hypogonadisme central ou périphérique) ; (6) un caryotype si la concentration de spermatozoïdes ≤ 10 millions/mL ; (7) l'évaluation des microdélétions du chromosome Y si la concentration ≤ 1 million/mL ; (8) l'évaluation du gène CFTR en cas de suspicion d'agénésie bilatérale ou unilatérale des canaux déférents et des vésicules séminales. La place et l'utilité des tests directs et indirects permettant d'évaluer les effets du stress oxydant sur l'ADN du spermatozoïde seront également précisés. Cette revue vient compléter et réactualiser les recommandations AFU/SALF 2021. Among couples consulting for infertility, there is a male component, either alone or associated with a female aetiology in around one in 2 cases. Bibliographic search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2023. The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound, ± an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration ≤ 10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration ≤ 1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained. This review complements and updates the AFU/SALF 2021 recommendations.

Background. - The role of urogenital infections in male infertility has long been the subject of debate.Methods. - A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles.Results. - Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved. Conclusion. - This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.(c) 2023 Elsevier Masson SAS. All rights reserved.

Background. - Treatments to stimulate spermatogenesis and antioxidant food supplements are often offered to infertile patients either before sperm extraction surgery to improve results, or as part of medically assisted reproduction or spontaneous fertility to increase the likelihood of a live birth.Methods. - A bibliographic search limited to English-language literature on men published before 5/2023 was carried out, including clinical trials, literature reviews and meta-analyses on spermatogenesis-stimulating molecules and antioxidant treatments. Results. - Several medical treatments seem capable of improving male fertility: they act mainly by stimulating spermatogenesis through hormones, or by reducing the effects of oxidative stress. With regard to oligoasthenozoospermia, the literature shows that certain hormonal treatments stimulating spermatogenesis are useful. In the case of non-obstructive azoospermia, the value of treatment depends on the patient's FSH and testosterone levels. AOX supplementation appears to improve certain spermogram parameters and have an impact on pregnancy and live birth rates.Conclusion. - This review should help urologists gain a better understanding of the various medical treatments and enable them to define an appropriate therapeutic strategy, tailored to the patient and the couple, in order to obtain the best results.(c) 2023 Elsevier Masson SAS. All rights reserved.

Background. - Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association francaise d'urologie (AFU) Comite d'andrologie et de medecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional infor-mation. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances.Methods. - Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. Results. - Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. Conclusion. - Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.(c) 2023 Published by Elsevier Masson SAS.

Urology has long remained the least feminized specialty. The objective of this study was to assess the demographic characteristics of female urologists and their feelings in terms of discrimination.The survey consisted of a questionnaire of 12 questions, sent by mailing to all female urologists, a first time in May 2016 (n=84), then a second time in January 2020 (n=98). The anonymized answers were analyzed and compared in order to assess the evolution over the last 4 years. The participation rate was 46.4% in 2016 (n=39 respondents) and 50% in 2020 (n=49 respondents).The majority of women worked full time (73.5%), with a hospital (38.8%), liberal (46.9%) or mixed (14.3%) activity. Their main theme was women's urology (57.1%). In 2020, 59.2% of respondents had encountered difficulties related to their status as women during their career and 28.1% difficulties related to motherhood. Female urologists in private practice were significantly less concerned than their counterparts with hospital or mixed activity (43.5% versus 73.1%, P=0.035). Women felt that they were underrepresented in association committees at 95.9% (vs. 82.1% in 2016) and in university positions at 79.6% (vs. 89.7% in 2016). Finally, 91.8% were in favor of the creation of an association of women urologists (vs. 53.8% in 2016).Women urologists may encounter difficulties related to their status as women during their professional career. Between 2016 and 2020, there is an increase in the feeling of under-representation within association committees and an increase in the need to federate.III, étude rétrospective cas-témoins.

Objectives. - To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. Method. - The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 refe-rences, of which 79 were selected and analyzed with the GRADE grid. Recommendations. - Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasec-tomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be parti-cularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interpo-sition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed. (c) 2023 Elsevier Masson SAS. All rights reserved.

Context. - Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden. Methods. - A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages.Results. - The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised. Conclusion. - The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.(c) 2023 Published by Elsevier Masson SAS.

Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden.A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages.The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised.The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.

Depuis les années 1970, on note un déclin quantitatif et qualitatif des paramètres spermatiques. La principale hypothèse pour expliquer une évolution aussi rapide est la mise en jeu de phénomènes environnementaux et comportementaux. Une recherche bibliographique limitée à la littérature en anglais et français chez l'homme publiée avant 7/2023 a été réalisée sur les liens entre fertilité et pollution, xéno-biotiques, tabac, stupéfiants, cannabis, alcool, poids, sport, sédentarité, sommeil et anabolisants. De profonds changements de mode de vie sont survenus depuis 50 ans : diminution du temps de sommeil, sédentarité, changements alimentaires, consommation de tabac, utilisation de stupéfiants et d'anabolisants. Ces changements ont un impact aujourd'hui prouvé sur les paramètres du spermogramme et devraient être corrigés dans un effort d'optimisation de la santé reproductive. D'autres paramètres environnementaux : pollution, exposition aux métaux lourds, exposition aux xénobiotiques, aux phtalates et aux pesticides… seront plus difficiles à exclure de la vie quotidienne des patients mais mériteraient d'être plus pris en compte. Cette revue devrait aider l'urologue dans l'évaluation et le conseil des patients afin d'améliorer leur santé reproductive. La recherche de ces facteurs devrait être systématique lors de l'exploration d'un homme infertile. Since the 1970s, there has been a quantitative and qualitative decline in sperm parameters. The main hypothesis to explain such a rapid evolution is the involvement of environmental and behavioral phenomena. A bibliographic search limited to English and French literature in men published before 7/2023 was carried out on the links between fertility and pollution, xenobiotics, tobacco, narcotics, cannabis, alcohol, weight, sport, sedentary lifestyle, sleep and anabolics. Profound changes in lifestyle have occurred over the past 50 years: reduced sleep time, sedentary lifestyle, dietary changes, tobacco consumption, use of narcotics and anabolics. These changes have a proven impact on spermogram parameters, and should be corrected in an effort to optimize reproductive health. Other environmental parameters: pollution, exposure to heavy metals, exposure to xenobiotics, phthalates and pesticides… will be more difficult to exclude from patients' daily lives, but deserve to be taken more into account. This review should help the urologist to assess and counsel patients in order to improve their reproductive health. These factors should be routinely investigated in infertile men.

Les traitements de stimulation de la spermatogenèse et les compléments alimentaires à visée anti-oxydante sont souvent proposés aux patients infertiles soit avant une chirurgie d’extraction de spermatozoïdes pour en améliorer les résultats soit dans le cadre d’une assistance médicale à la procréation ou en fertilité spontanée pour augmenter la probabilité d’une naissance vivante. Une recherche bibliographique limitée à la littérature en anglais chez l’homme publiée avant 5/2023 a été réalisée incluant les essais cliniques, les revues de la littérature et les méta-analyse sur les molécules stimulant la spermatogenèse et les traitements anti-oxydants. Plusieurs traitements médicaux semblent capables d’améliorer la fertilité masculine : ils agissent principalement en stimulant la spermatogenèse de manière hormonale, ou en réduisant les effets du stress oxydant. Concernant les oligoasthénospermies, la littérature montre un intérêt de certains traitements hormonaux stimulant la spermatogenèse. Concernant les azoospermies non obstructives, l’intérêt du traitement se discute en fonction des niveaux de FSH et de testostérone des patients. La supplémentation en AOX semble améliorer certains paramètres du spermogramme et avoir un impact sur les taux de grossesses et de naissances vivantes. Cette revue devrait aider l’urologue à mieux appréhender les différents traitements médicaux et lui permettre de définir une stratégie thérapeutique appropriée, adaptée au patient et au couple, afin d’obtenir les meilleurs résultats. Treatments to stimulate spermatogenesis and antioxidant food supplements are often offered to infertile patients either before sperm extraction surgery to improve results, or as part of medically assisted reproduction or spontaneous fertility to increase the likelihood of a live birth. A bibliographic search limited to English-language literature on men published before 5/2023 was carried out, including clinical trials, literature reviews and meta-analyses on spermatogenesis-stimulating molecules and antioxidant treatments. Several medical treatments seem capable of improving male fertility: they act mainly by stimulating spermatogenesis through hormones, or by reducing the effects of oxidative stress. With regard to oligoasthenozoospermia, the literature shows that certain hormonal treatments stimulating spermatogenesis are useful. In the case of non-obstructive azoospermia, the value of treatment depends on the patient's FSH and testosterone levels. AOX supplementation appears to improve certain spermogram parameters and have an impact on pregnancy and live birth rates. This review should help urologists gain a better understanding of the various medical treatments and enable them to define an appropriate therapeutic strategy, tailored to the patient and the couple, in order to obtain the best results.