Varicocele is a common entity found in 15% of men and is the most common reversible cause of male factor infertility. Guidelines have been developed to guide urologists in deciding which patients would benefit from varicocelectomy. Yet studies published over the last decade showed the emergence of predictors of success of varicocelectomy using nomograms and other predictive models with statistical analysis. The emergence of artificial intelligence (AI) and machine learning revolutionized the clinician's approach to medicine. The virtual branch of AI, represented by machine learning, has been a very exciting topic for clinicians and researchers over the last years, especially after the launching of ChatGPT-3.5. Urology has been at the forefront of integrating advances in AI into its everyday practice. We aim to shed light on the present literature describing the use of AI in predicting the outcomes of varicocelectomy. Machine learning is being used to predict the improvement in semen parameters after varicocelectomy. These algorithms are derived from studies and data present in the literature and predictive models developed throughout the last two decades and have a superior performance to that of traditional nomograms. However, these models require further research and validation but are anticipated to surpass the accuracy of all current resources, setting forward a new era of varicocele workup and management in the years to come. This paper offers a wide review on the current evidence behind varicocele surgery and the integration of AI in medicine, urology and its use in predicting improvement in sperm parameters post-varicocelectomy.

Male infertility contributes to 20%-70% of infertile couple cases worldwide. One of the key challenges in this area is asthenozoospermia or reduced sperm motility. A particular subset, known as isolated asthenozoospermia (iASZ), in which low motility occurs without abnormalities in sperm count or shape, often goes unnoticed and is not well understood. This narrative review attempts to compile the state of knowledge regarding the etiology, diagnosis, and treatment of iASZ and to identify knowledge gaps that need further investigation with an emphasis on physiological, genetic, and molecular mechanisms. We conducted a focused literature search using PubMed and Web of Science, covering studies published between 2000 and 2024. We included articles that explored the structure, function, diagnosis, and treatment of iASZ. We find sperm motility is influenced by multiple factors, from structural components like mitochondria and the flagellum, to biochemical signals and genetic mutations. In men with iASZ, issues such as mitochondrial dysfunction, oxidative stress, or specific gene defects may impair motility. While routine semen analysis helps flag low motility, it often fails to explain why it occurs—highlighting the need for advanced tests like DNA fragmentation tests, genetic screening, and high-resolution imaging. As regards treatment, lifestyle changes, varicocele surgery, and antioxidants can offer some benefit. Assisted reproduction techniques, especially intracytoplasmic sperm injection (ICSI), remain central for achieving pregnancy when other options fail. iASZ deserves more attention as a distinct and treatable cause of male infertility. By improving how we diagnose and manage this condition, supported by further research, we can offer better outcomes for affected couples hoping to conceive.

Ten percent of infertile males have azoospermia, classified into obstructive and nonobstructive types, which require specific medical or surgical treatments. In nonobstructive azoospermia, advancements in microsurgery allow for effective sperm retrieval in about half of cases. This review aimed to highlight the most recent studies utilizing whole exome sequencing (WES) and seminal/serum biomarkers aim to predict micro-dissection testicular sperm extraction (micro-TESE) outcomes and reduce failure rates. WES identifies rare genetic mutations affecting spermatogenesis that could explain micro-TESE failures, improving preoperative assessments. Despite its potential, WES is limited by high costs. Biomarkers such as Anti-Müllerian Hormone and testis-expressed sequence 101 protein can indicate spermatogenic activity, though standardization of these measurements is needed for accuracy. Additionally, microRNAs as non-invasive markers offer potential in assessing spermatogenic reserve and classifying azoospermia types, but their efficacy in identifying specific spermatogenic disorders remains under researched, necessitating further studies on multivariate miRNA models.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, affecting over 50% of men aged 50 and older. ED is often linked to lifestyle factors and comorbidities, such as diabetes and cardiovascular disease. Although conventional treatments such as phosphodiesterase type 5 inhibitors (PDE5is) and penile prostheses are commonly used, there is increasing interest in regenerative therapies, including platelet-rich plasma (PRP), which may address the underlying causes of ED. This narrative review examines ongoing trials on intracavernosal PRP for ED to better understand its potential as a treatment and offers recommendations for future research to improve the quality of evidence supporting its use. A literature search was conducted in December 2024 across PubMed, ScienceDirect, and Scopus for articles evaluating PRP for ED. The keywords used for search were PRP, ED, and randomized controlled trial. The review focused on relevant studies, with titles, abstracts, and full texts examined for key details. Five randomized clinical trials, two meta-analyses, and a systematic review were identified, revealing significant variability in PRP preparation, dosage, and follow-up protocols, which hindered definitive conclusions about its efficacy. Although the available evidence suggests promising potential for PRP in ED treatment, methodological inconsistencies highlight the need for further research. Standardization of PRP preparation and administration protocols, along with larger and longer-term trials, is essential to establish its clinical benefits for ED treatment.

Background: Obstructive azoospermia (OA) is a prevalent cause of male infertility in Qatar and globally, with vasectomy reversal (VV) and vasoepididy-mostomy (VE) being the primary surgical treatments. While microsurgical techniques have advanced, data from the Middle East remain limited, influenced by the region's distinct demographic and cultural factors. This study aimed to evaluate the outcomes of microsurgical VV and VE performed for OA in a tertiary center in the Middle East, with a focus on success rates, influencing factors, and the unique regional characteristics of OA.

Methods: A retrospective cohort study analyzed 105 patients with OA undergoing VV or VE over a period of 10 years. Data on demographics, clinical variables, surgical findings, and postoperative outcomes were assessed. Success was defined as sperm presence in semen within 3-6 months post-surgery.

Results: The overall success rate for VV was 85.7%, with similar rates across bilateral and unilateral procedures. VE success was 50%, with bilateral intussusception technique yielding superior outcomes (71.9%). Factors predicting success included shorter obstructive interval for VV and bilateral reconstruction for VE.

Conclusion: Microsurgical VV remains a reliable first-line treatment for OA, achieving high success rates consistent with international benchmarks. VE presents greater variability in outcomes, highlighting the complexity of managing epididymal obstruction and the importance of advanced surgical techniques like intussusception. The distinct etiological patterns observed in the Middle East emphasize the need for tailored approaches to diagnosis, surgical planning, and patient counseling.

Background: Prostate cancer, a prevalent malignancy in men, often results in erectile dysfunction (ED), particularly following treatments like radical prostatectomy (RP) and radiotherapy, significantly affecting quality of life. Managing ED in prostate cancer survivors is critical. Inflatable penile prosthesis (IPP) implantation is a well-established treatment for ED, yet the literature on satisfaction rates for patients with a history of androgen deprivation therapy (ADT) remains sparse. We aimed to investigate the impact of ADT on satisfaction rates in patients undergoing IPP implantation following RP or radiation therapy (XRT).

Methods: A retrospective review of 529 patient charts identified 96 eligible patients who underwent IPP implantation post-prostate cancer treatment and completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients were stratified into two groups based on ADT status, and their satisfaction scores were compared. Effect sizes were used to assess clinical relevance alongside statistical significance (p = 0.0344).

Results: Patients receiving ADT had significantly lower EDITS scores (p = 0.0344) compared to those not on ADT. RP patients reported higher satisfaction post-IPP compared to XRT patients, even after controlling for ADT. Additionally, coronary artery disease (CAD) was associated with lower satisfaction scores.

Conclusion: ADT significantly lowers patient satisfaction post-IPP, with RP patients generally reporting higher satisfaction than XRT patients. These findings highlight the importance of counseling prostate cancer patients on ADT's impact on long-term sexual satisfaction and suggest areas for further research to enhance outcomes.