During the evaluation of an infertile male, there are many factors to be considered as potential contributors. The environment is ubiquitous around us and therein lies many factors that can negatively influence male reproductive potential. Pollution and pesticides can adversely impact fertility in many ways, such as through the creation of reactive oxygen species, a direct toxic effect, and even disrupting steroidogenic pathways. Everyday items such as cellular phones can generate electromagnetic waves that increase the formation of reactive oxygen species leading to DNA fragmentation and apoptosis. Laptop computers can increase scrotal temperatures, thereby influencing spermatogenesis. Foods may contain phytoestrogens that display estrogenic effects. In this chapter, we evaluate the evidence of some of the environmental factors clinicians need to consider in the work-up of male-factor infertility.

The inflatable penile prosthesis (IPP) is an effective erectile dysfunction (ED) treatment modality when oral and injectable therapies fail to achieve satisfactory results. Unfortunately, infection of the prosthetic remains a dreaded complication occurring in a small fraction of patients despite advances in device design and surgical techniques. With a prosthetic infection or erosion, classic management has included removal of all hardware with thorough irrigation of the infected spaces. To prevent corporal fibrosis and scarring that can make a subsequent implant challenging, an immediate salvage procedure with a three-piece prosthesis has been advocated when possible. However, there has been recent interest in using malleable devices during salvage procedures to serve as a temporary implant and further improve outcomes. Based on a literature review of immediate salvage procedures for infected penile prostheses, management with typical Mulcahy washout and IPP reimplant may be quite successful in appropriately selected patients. Based on one case series and a second multicenter trial of malleable salvage procedures, utilizing a malleable as a temporary implant is similarly, if not more, successful at eradicating prosthetic infection. The malleable implant not only serves as a temporary space-filling corporal implant to prevent fibrosis, but may also prove an adequate destination therapy for some given the lower than expected rate of delayed conversion to inflatable prosthesis. Future studies are needed to better characterize the role of malleable devices for penile prosthetic salvage and query patient satisfaction with the malleable device and repeated surgeries.

Infertility occurs in 15% of the population; and 30–50% of the time, the problem is due to a male factor. There is active research attempting to elucidate how male factor infertility fits into the picture of overall men’s health. Research in the past has established that a thorough male fertility evaluation can uncover various medical pathologies. There is now growing evidence that suggests male infertility is a potential harbinger for subsequent cancer development. In this review of pertinent articles, the current evidence regarding fertility and development of genitourinary and other cancers will be discussed, in particular, testicular and prostate cancer. In addition, various etiologic factors that explain the pathophysiology of infertility and progression to cancer will also be reviewed. It is possible that male factor infertility is a surrogate marker for subsequent cancer development.