Holmium laser enucleation of the prostate (HoLEP) has emerged as a widely adopted surgical technique for the management of benign prostatic hyperplasia (BPH), regardless of prostate size; however, its impact on male sexual function—particularly in terms of erectile and ejaculatory outcomes—remains a subject of ongoing debate. The aim of this study is to critically evaluate the effects of HoLEP on male sexual function (SF), with emphasis on erectile and ejaculatory outcomes, intraoperative considerations, and comparative effectiveness versus other surgical treatments for BPH. The narrative review was conducted using PubMed, Web of Science, and Google Scholar to identify English-language clinical studies, cohort trials, randomized controlled trials, and meta-analyses published between January 2000 and May 2025. Included studies evaluated SF before and after HoLEP using validated tools such as the International Index of Erectile Function (IIEF) and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). The literature indicates that HoLEP has a neutral to modestly favorable effect on erectile function (EF). Transient declines may occur in the early postoperative period, with most patients returning to baseline by three to six months. In contrast, retrograde ejaculation is a frequent and expected outcome, with incidence rates typically ranging from 74% to 78%. While various surgical modifications—such as modified enucleation techniques and partial apical preservation—have demonstrated potential in preserving ejaculatory function, outcomes remain inconsistent and poorly standardized. HoLEP is an effective and durable treatment for BPH with a stable EF profile but a high likelihood of ejaculatory dysfunction. Although promising ejaculation-sparing techniques exist, robust evidence supporting their routine use is lacking. Future research should focus on standardized intraoperative strategies, validated patient-reported outcome measures, and personalized approaches to optimize both urinary and sexual outcomes.

Sexual dysfunction, including erectile dysfunction and penile shortening, is a frequent consequence of radical pelvic surgeries such as prostatectomy, cystoprostatectomy, and rectal cancer surgery. These complications primarily result from nerve injury and hypoxia-induced corporal fibrosis. As survivorship care gains prominence in oncology, preserving sexual function and penile anatomy has become a critical objective. Penile traction therapy (PTT) is a non-invasive intervention that applies controlled mechanical stretch to the penis. Through mechanotransduction, PTT may stimulate tissue remodeling, preserve length, and reduce fibrosis. Initially developed for Peyronie's disease, PTT is now being explored for penile rehabilitation following pelvic surgery. Preliminary clinical studies, including randomized controlled trials, suggest that early initiation of PTT may help maintain or even improve penile length and erectile function (EF). Treatment is generally well tolerated, with high adherence and minimal side effects. The advent of second-generation devices, offering enhanced ergonomics and reduced daily usage times, has further improved feasibility and patient compliance. This review outlines the pathophysiological basis of post-surgical penile changes, the mechanism of action of PTT, and the emerging evidence base for its use in the post-oncological setting. Although PTT use remains off-label in this context, it represents a promising component of multimodal penile rehabilitation strategies. Its broader adoption is currently limited by barriers such as device cost, lack of insurance coverage, and the absence of standardized protocols. Structured follow-up, patient education, and multicenter long-term studies are essential to validate efficacy, establish best practices, and optimize accessibility for patients recovering from radical pelvic surgery.

Erectile dysfunction (ED) is one of the most frequent and distressing complications after radical prostatectomy (RP), significantly impairing patients’ quality of life and intimate relationships. Penile rehabilitation (PR) aims to preserve erectile tissue integrity, prevent fibrosis, and facilitate early functional recovery by restoring oxygenation to the corpora cavernosa. Current PR strategies include oral phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, and vacuum erection devices, used alone or in combination. Adjunctive options, such as low-intensity shockwave therapy, stem cell therapy, and platelet-rich plasma, are currently under investigation. Despite widespread use, there is no standardized PR protocol, and evidence remains mixed regarding optimal timing, dosage, and duration. This review summarizes contemporary and emerging PR modalities, highlighting evidence-based principles, patient selection, and integration of preoperative counseling to set realistic expectations. Psychosocial support, partner involvement, and multidisciplinary collaboration are essential to maximize adherence and recovery. Future research should prioritize high-quality randomized controlled trials to define standardized, evidence-based PR protocols tailored to individual risk profiles and preferences, ultimately improving functional recovery and quality of life after RP.

Robot-assisted radical prostatectomy (RARP) has become the standard surgical approach for treating localized prostate cancer. A crucial component of RARP is nerve-sparing surgery (NSS), which significantly improves postoperative erectile function and urinary continence. The primary aim of NSS is to preserve the neurovascular bundles, but this must be balanced with oncological safety, particularly concerning the risk of positive surgical margins when extracapsular extension is present. This review aims to provide an overview of NSS techniques, based on the authors' clinical experience and perspective, while avoiding unnecessary technical overdetail.

Supersonic transporter (SST) deformity, also known as floppy glans syndrome, represents a persistent source of post-operative dissatisfaction among patients undergoing inflatable penile prosthesis (IPP) implantation. Although infection and mechanical failure rates have declined with advances in device design and surgical technique, SST deformity remains a challenging anatomical complication. It results primarily from inadequate corporal dilation, undersized or malpositioned cylinders, or true glans hypermobility due to disruption or weakness of the corporo-glanular ligament. Diagnosis is largely clinical, supported by adjunctive imaging when needed, while the glans hypermobility scale has emerged as an objective tool for intra-operative grading and decision-making. Conservative approaches such as observation, phosphodiesterase type-5 inhibitors, intraurethral vasoactive agents, and vacuum therapy may offer benefit in mild cases, but durable correction is most consistently achieved through glanulopexy techniques, which now demonstrate success rates exceeding 85%–95% with low morbidity. This review synthesizes historical perspectives, evolving diagnostic approaches, and contemporary surgical management strategies for SST deformity. Future research into minimally invasive fixation and injectable bulking agents may further expand the treatment armamentarium for this complex but correctable cause of dissatisfaction following IPP implantation.

Background: Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, with common metastatic sites including the lungs, bones, liver, and brain. Omental metastasis is exceedingly rare and usually occurs postoperatively. Fumarate hydratase-deficient (FH-deficient) RCC, a recently classified and highly aggressive subtype of RCC, is known to show early metastatic potential but remains poorly understood. We present a rare case of synchronous FH-deficient RCC with isolated omental metastasis identified at diagnosis.

Case Presentation: We report the case of a 48-year-old man who first presented with abdominal pain, early satiety, and a 25-pound weight loss. Imaging revealed an 11.8 cm right renal mass with a separate 15.4 cm left upper quadrant mesenteric mass with no definitive evidence of lung, bone, or liver involvement. Biopsies of both renal and mesenteric masses confirmed non-clear-cell FH-deficient RCC with papillary architecture and diffuse overexpression of 2-succinyl cysteine.

Conclusion: Omental metastasis of RCC is rare, especially in the absence of prior surgery. This case is distinguished by its synchronous presentation of the primary RCC and omental metastasis with a rare histologic subtype. Unlike most documented reports of RCC with omental spread, which typically involve clear cell histology and often present years after nephrectomy, this case involves a rare, aggressive subtype with atypical metastatic behavior. This case underscores the importance of considering atypical metastatic patterns in non-clear-cell subtypes and the need for further research to inform evidence-based therapy.

Backgroud: Persistent Müllerian duct syndrome (PMDS) is a rare condition characterized by the persistence of Müllerian duct structures in genotypic and phenotypic males.

Case Presentation: We present the case of a 4-month-old male with PMDS who presented with transverse testicular ectopia. The patient underwent diagnostic laparoscopic orchiopexy with preservation of the Müllerian structures to maintain future fertility options. Due to the abnormal appearance of the testes, a biopsy revealed normal testis tissue without any ovarian tissue. Genetic testing identified a unique mutation in each copy of the AMHR2 gene: c.322A>C and c.658G>C. Neither mutation has been previously reported.

Conclusion: This case highlights the importance of considering PMDS in male infants presenting with transverse testicular ectopia. Early recognition and fertility-preserving surgical management are essential, and novel genetic variants continue to expand the mutational spectrum of AMHR2-related PMDS.