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Perhaps one of the most exciting and revolutionary scientific discoveries of the past 3 decades has been the development of in vitro fertilization (IVF) to treat human infertility. It is impossible to quantify its effect on numerous families since the first IVF birth in 1978 in Old-ham, England (Steptoe and Edwards, 1978). With increasing clinical utilization of assisted reproductive technologies (ART), scientists and clinicians gain insights into basic gamete and embryo biology and translate that knowledge into improving the process of IVF. Critical analyses of individual steps have improved outcomes. Attention to sperm processing and isolation to increase recovery of motile sperm and reduce sperm damage has improved fertilization rates and embryo development (Mortimer, 1994). Use of intracytoplasmic sperm injection (ICSI) has allowed fertilization even in severe cases of compromised sperm quality or number (Bonduelle et al, 1999). Finally, refinement of embryo culture has led to improved in vitro embryo development and implantation rates (Gardner and Lane, 1998; Pool, 2002). Most scientific attention, however, has focused on methodologies rather than technology development and equipment. Semen is still processed in test tubes regardless of technique, sperm are physically placed with oocytes after processing, and fertilization and embryo culture occur in culture dishes, test tubes, or both with relatively large volumes (Trounson and Gardner, 2000). With the exception of gamete and embryo micromanipulation, no technologic advancements in IVF have reached widespread use. Nevertheless, it is precisely those technologic advancements, rather than procedural or methodology changes, that have had the greatest effect on assisted reproduction. A promising new technology, microfluidics, exists and is becoming increasingly studied. This technology shows promise as an alternative for each step in the IVF process. Microfluidics, based on physical principles of fluid behavior in a microenvironment, has been used widely in chemistry and molecular biology applications (Tomlinson et al, 1995). Currently, microfluidics is gaining interest in studies of cellular behavior and interactions (Shim et al, 2003). In this article, we introduce basics of fluid behavior at the microscale and highlight previous uses of this technology outside of the reproductive sciences. We then describe fabrication of devices and review initial studies that used microfluidics in sperm sorting and microinsemination. Last, we point out some limitations of this new technology and provide speculation on future directions and application of microfluidics in ART. Fluid mechanics is a complex physical and mathematical science; therefore, an extensive technical description and review of fluid physics is beyond the scope and intent of this review. Instead, basic principles will be discussed that govern fluid behavior in a microenvironment, especially those aspects with a specific link to devices and technology currently being developed for IVF. We have purposely avoided including mathematical details, choosing instead to convey a general conceptual sense of fluid mechanics present within microchannels. A comprehensive technical and mathematical description of microfluidic physics can be found in excellent reviews from Beebe et al (2002a) and Brody et al (1996). Fluids at the microscale are subject to forces typically not important at scales present in our everyday lives. Fluid at the scale of our normal environment is turbulent; particles within a stream of fluid move in an unpredictable pattern. Turbulent flow depends on certain fluid characteristics (viscosity, density, and velocity) and the geometry and size of the channel, leading to calculation of a value known as the Reynold's number. As the scale of the channel reaches micrometer levels, the Reynold's number decreases and becomes increasingly dependent on fluid characteristics. Decrease of the Reynold's number below a threshold value leads to fluid flow in a laminar fashion. Simply put, flow within microchannels becomes streamlined and predictable (Figure 1). At the microscale, fluid behavior becomes increasingly governed by viscous forces and surface tension, which can be described as the cohesiveness of the liquid's molecules. . Schematic representation illustrating fluid mixing in turbulent (A) and laminar (B) flow patterns. This dominance by viscous forces results in several interesting phenomena. Flows with a low Reynold's number possess little to no momentum; thus, fluids within a microchannel respond quickly and reliably to changes in external forces. In addition, at the microscale, 2 or more streams of laminar flow in contact with each other do not mix, except by diffusion of molecules across the interface of the streams. The rate of diffusion between the contacting surfaces at the microscale can be very quick, partially because of the relatively short distances needed to cross fluid volumes. Many of these fluid characteristics at the microscale form the principles driving the interest in the use of microchannels for gamete and embryo manipulation. In general, a microenvironment more closely resembles the in vivo conditions of fertilization and development when compared with a culture dish or drop of media. Below, we discuss the theory behind investigating the use of microfluidics in andrology, its testing, limitation, and potential future influence. Interest in microfluidics began with attempts to miniaturize chemical and biological analysis devices in the laboratory (Kricka, 1998). Current designs are often referred to as “laboratory-on-a-chip” or micrototal analysis systems (μTAS) and function by allowing a variety of chemical processes and interactions to occur as fluid flows within their miniature channels and chambers (Weigl and Yager, 1999). Such devices perform all the analytical functions necessary for their purpose, including sample handling, mixing, incubation, sorting, transport, interaction, and detection or signaling within an integrated microfluidic “chip.” Examples include, but are not limited to, immunoassays for antibodies present in serum (Linder et al, 2002) and assays determining enzyme reaction kinetics (Xue et al, 2001; Yakovleva et al, 2002). Additional applications in cellular biology have emerged, such as integrated cell sorting devices working at the microscale (Fu et al, 2002) and microfluidic devices that allow for the study of cellular interactions with substrates or other cells (Shim et al, 2003). Advances in cell biology have been demonstrated with the use of microfluidics and the principle of laminar flow, allowing for selective exposure of subcellular areas of interest to membrane-permeable molecules (Takayama et al, 2001). Such precise delivery of molecules to cellular subdomains illustrates the precision with which microfluidic regulation of fluid flow is capable. Advantages of such laboratory-on-a-chip technology are multiple. First, once designed and tested, the manufacture of such devices is straightforward and inexpensive, allowing them to be disposable (McDonald et al, 2000). Microfluidic analysis devices use very low volumes of samples and reagents and provide for faster reactions and response times (Weigl and Yager, 1999). Miniaturization very importantly allows for integration of multiple processes within a small, self-contained unit (Kricka, 1998). This can be translated into either multiple parallel analyses, consecutive serial processes, or both. The brief overview given here is only intended to familiarize readers with the variety of capabilities of microfluidic technology and is by no means a comprehensive listing of microfluidic applications in sciences. Readers are encouraged to consult more thorough reviews (Khandurina and Guttman, 2002; Verpoorte, 2002). Microfluidics systems were initially fabricated with the use of materials and techniques common in the industry that inspired them—microelectronics (McDonald et al, 2000). Photolithography and etching of silicon and glass was a highly developed technology also readily available to researchers interested in miniaturizing analytical systems, yet costs were a significant barrier. In search of a suitable alternative, polymers have quickly emerged as a material for microfluidic biological device fabrication (McDonald et al, 2000). Compounds such as poly(methyl)methacrylate (Martynova et al, 1997), fluorinated ethylene propylene (Sahlin et al, 2002), and poly(dimethylsiloxane) (PDMS; McDonald and Whitesides, 2002) are cheaper and easier to manipulate than silicon-glass alternatives (Martynova et al, 1997). PDMS in particular has become one of the most actively explored and promising materials thus far, possessing numerous characteristics specifically suitable for biological use. It is nontoxic, transparent, insulating, and permeable to gases (McDonald and Whitesides, 2002). From a fabrication standpoint, PDMS permits submicron fidelity with molding, cures at low temperatures, and can easily seal reversibly to itself and a host of other materials (McDonald et al, 2000). Although PDMS is generally regarded as nontoxic, special consideration must be given to its use with gametes and embryos, which can be very sensitive to their environment compared with transformed cell lines. Before the use of microfluidic devices with sperm, testing confirmed that no negative effects resulted from prolonged exposure to the materials used in their fabrication. Schuster et al (2003) reported that 30 minutes of exposure to PDMS did not alter sperm survival. In addition, Glasgow et al (2001) found that development of 2-cell mouse embryos to the blastocyst stage was unchanged by continuous exposure to numerous photolithography compounds compared with controls. Thus it appears that PDMS-composed microchannels or the materials used in their construction do not confer deleterious effects to gametes or embryos. Numerous efforts have improved methods of semen processing and sperm isolation. Currently, swim-up techniques or density gradient separation are methods of choice (Trounson and Gardner, 2000). Both methods result in adequate recovery of motile sperm, although additional steps might be necessary in poor-quality semen samples (Bourne et al, 1995a,b). However, some researchers have stated concern that these methods could contribute to sperm morphological damage, DNA damage, production of oxygen-free radicals, or multiple injuries (Aitken and Clarkson, 1988; Zini et al, 1999). In addition, these techniques can be labor and time intensive. Ideal sperm isolation would involve a simple, rapid, and atraumatic method to obtain sufficient motile sperm for use in either IVF or ICSI, depending on need and the quality of the original semen sample. Attempts have been made to develop devices for such a purpose. The Wang tube (Wang et al, 1992), a uniquely configured glass tube, allows motile sperm to progress to an upper arm that is then separated for sperm use in intrauterine insemination or IVF. Comparison testing with swim-up and density gradient separation for normozoospermic samples revealed greater motility and morphology with the device (Wang, 1995). Lih et al (1996) have developed and tested a Lucite microchamber consisting of a central loading well surrounded by slightly depressed sidewells that was conceived from the observation that motile sperm migrate to the periphery of microdrops. This device concentrated motile sperm up to 13-fold in the sidewells, yielding a sufficient number for use in ICSI. A microfluidic device has been explored for sperm diagnostic purposes. Kricka et al (1993) designed and fabricated silicon and glass devices for sperm motility evaluation. They evaluated sperm progression along the length of a microchannel (80 μm wide by 20 μm deep) and navigation through a network of branching channels. In initial studies, they demonstrated feasibility and hypothesized that this device could replace conventional methods of motility assessment and semen analysis. Subsequently, they demonstrated that sperm movement within microchannels, judged by the time needed to reach the end of the channel, correlated with forward progression scores (Kricka et al, 1997). However, the design of the device did not give reliable information regarding sperm concentration or percent motility and therefore could only serve as an adjunctive test of motility and forward progression rather than a comprehensive semen analysis tool. Schuster et al (2003) developed a microfluidic device taking advantage of parallel laminar flow streams present at the microscale. In this device, a flowing stream of semen was placed in parallel with a flowing stream of media within a microchannel. Flow within microchannels was maintained by a novel gravity-driven, horizontally oriented pumping system developed specifically for the device (Cho et al, 2003). As discussed, these 2 parallel laminar flow streams mix only by diffusion. Motile sperm demonstrated the ability to actively propel themselves across contacting surface areas and deviated from the initial streamline into the media stream for collection, whereas nonmotile sperm and cellular debris remained in the initial stream and exited the device (Figure 2). . (A) Picture of microfluidic sperm sorter. (B) Three-dimensional view of microfluidic sperm sorter. (C) Theoretical vision for microfluidic sperm sorter. Media flows from left to right. (C, D) Semen sample is loaded into the upper stream inlet, and fresh media is placed in the lower stream inlet. (C, E) Motile sperm are able to deviate from the initial streamline and cross the interface of the laminar flow streams, exiting into the lower stream outlet for recovery. Debris, nonmotile sperm, and some motile sperm are collected in the upper stream outlet. Testing of this laminar flow sorting system was performed with 40 μL of unprocessed human semen, followed by semen samples artificially filled with debris from a stock solution of round immature germ and white blood cells to simulate poor-quality samples. For unprocessed semen, the device consistently produced a sorted fraction with increased motility (mean 98% motile) and improved Kruger strict sperm morphology (mean 22% normal forms) compared with the initial specimen (mean 44% and 10%, respectively). For debris-filled samples, the device not only concentrated motile sperm (mean 98% motile) within the collected fraction, but was also able to produce a round cell:sperm ratio of 1:33 compared with a 10:1 ratio in the starting specimen (Schuster et al, 2003). Microfluidics might be particularly suitable for IVF for a number of reasons (Suh et al, 2003). The microenvironment of a microchannel more closely resembles in vivo fertilization conditions than a culture dish or microdrop. Microfluidic channels allow for nonturbulent bathing of gametes with fresh media throughout insemination and coincubation. Sperm-oocyte interactions occur in an active environment, rather than the static conditions present in a culture dish or droplet. In addition, sperm can be predictably delivered via laminar flow to each oocyte within the microchannel, eliminating the randomness of sperm-oocyte interaction. In a culture dish, sperm can travel randomly in any direction, thereby relying on random sperm movement toward the oocytes; however, in a microchannel environment, sperm movement is limited by the direction of flow, allowing for active transport to the oocytes. Finally, microchannel environments use extremely small volumes of media, theoretically requiring fewer sperm to achieve insemination concentrations equal to standard IVF with larger volumes. Previous investigators have attempted, with some success, to reduce the volume of insemination medium with various low-volume vessels, although none have gained widespread acceptance. Van der Ven et al (1989) tested the use of sterile, nonheparinized hematocrit capillary tubes (75 mm length, 0.9 mm inner diameter) for IVF in humans. Normospermic samples were used with standard culture tubes as controls. Volumes of 5–10 μL containing a range of 500–4000 sperm per oocyte were used in these capillary tubes. Overall fertilization rates between controls and capillary tubes was similar (78% and 66%, respectively), although slightly lower for sperm totals of 500–1000 (56%) compared with 2000–4000 total sperm (79%). Ranoux and Seibel (1990) used embryo cryopreservation straws in volumes up to 200 μL (Ranoux et al, 1988) with 2000–4000 motile sperm. Results compared favorably with controls, with 167 of 322 oocytes (51.8%) fertilized by the straw technique. We have recently demonstrated that mouse IVF can be conducted successfully within microfluidic channels (unpublished data). Not only are lower total numbers of sperm required because of the use of media we have also demonstrated fertilization within microchannels with lower insemination sperm We to develop design that will result in increased and of use. Such microfluidic devices be in clinical not only for but as a for standard This microfluidic sperm sorting device a simple, atraumatic method of motile sperm of normal morphology from both unprocessed normal semen and poor-quality containing significant A of the device the flow at In its it is not of processing an semen however, it provide a means of quickly and easily a small sample of motile sperm of normal morphology for ICSI, insemination in or in an integrated microfluidic device et al, data). In addition, and in the design are in progress that might allow for processing in parallel and increased of flow and sorting (Schuster et al, 2003). As with any new technology, design an important in loading which can allow for of the outcomes. of oocytes and sperm to the device a which time outside of the environment, has significant deleterious effects on gamete and survival. of this time currently a significant Last, the of more but for fluid flow Current studies are focused on a of the gravity-driven, horizontally oriented pumping system et al, from the microfluidic sperm developed by et al (2003) and its application to microfluidic Although of the with microfluidics in IVF has been performed in a the of process and microfluidic technology is Use of microfluidic technology for sperm processing results in a small volume and fraction of motile sperm. Such volumes are to use and translate into a However, laminar sperm have been used for fertilization within a microenvironment (unpublished data). of a microfluidic channel for the oocyte and the stream of sorted sperm would result in of the oocyte with these motile sperm. the oocyte can be to a for for and embryo culture review in Beebe et al, media can be for embryo step the with no cell other than flow along a variety of channels. Miniaturization allows the system to be small and by laboratory not only decreases gamete and embryo but also for greater of multiple in integration of these The development of reliable methods for flow through a network of channels is numerous active and et al, or (McDonald et al, have been designed for microfluidic but the to gamete and embryo must be delivery of fluid at precise rates is important for sperm sorting, culture media and embryo manipulation. A fluid has been for microfluidic sperm sorting (Cho et al, and active regulation of fluid flow with has been used for insemination and embryo et al, 2000). we developed a new microfluidic system with up to of and by on a (Figure et al, these are used as a for the The can a to of small individual on each of the cells cells for a total of and A of these cells would typically a of by a We advantage of the rate and size of the by the microchannels, them at The system advantage of the yet of PDMS microchannels fabricated with and the movement of to fluid through channels. of a can be used to a forward or flow of through the microchannel when to various patterns. The volume of flow per can be by the volume of by the This method of is and are can be and have in devices the size of a With this new we have demonstrated 3 functions necessary for future application of microfluidics for and embryo culture and analysis and and Finally, methods of fabrication and of microfluidic devices must be widespread of this technology for human Current devices have been for purposes. However, development of an IVF laboratory-on-a-chip is a and exciting . (A) A that can be used in with microfluidic (B) for and of (C) that have been in a microfluidic with media of various a microchannel of media is is the is depressed up the PDMS which into the channel to the media. This can be used to or or when into microchannels in this media pumping within the microchannel.

BACKGROUND: Conflicting results on testicular stiffness in varicocele and the lack of a standardized measurement protocol hinder clinical staging. In this study, we aimed to investigate the effects of probe frequency and region of interest (ROI) size selection on testicular stiffness measurements and to evaluate the testicular parenchymal stiffness and volume changes in patients with varicocele compare with healthy controls under standardized conditions. RESULTS: Shear wave elastography (SWE) was first performed on 62 testes from 31 healthy men, with two probe frequencies (SL10&#x2013;2 and SL15&#x2013;4) and four ROI sizes (4, 6, 8, and 10&#xa0;mm), to assess the impact on SWE measurements. Based on the lowest variability settings, testicular volume and stiffness were compared in 76 patients with varicoceles and 68 healthy controls. Different SWE values were obtained with the two probes and four ROI sizes (p&#x2009;<&#x2009;0.05). The SL15&#x2013;4 probe showed lower variability, with the lowest coefficient of variation at the 4&#xa0;mm ROI. The median testicular SWE value was 2.03 (1.97&#x2013;2.07) kPa in the control group and 2.01 (1.87&#x2013;2.07), 1.77 (1.53&#x2013;1.98), and 1.51 (1.45&#x2013;1.63) kPa in the Grade I, II, and III varicocele groups, respectively. SWE values were significantly lower in varicocele patients and decreased with increasing grade. The median testicular volumes were 13.08 (12.06&#x2013;15.70) mL in the control group and 12.26 (10.70&#x2013;15.15), 13.06 (11.34&#x2013;14.72), and 11.84 (11.26&#x2013;12.86) mL in the Grade I, II, and III varicocele groups, respectively. No significant difference in volume was observed between varicocele and control groups (p&#x2009;=&#x2009;0.387). CONCLUSION: Probe frequency and ROI size influence testicular SWE measurements, and caution should be exercised when comparing SWE results. Our study showed that testicular stiffness was decreased in patients with varicocele without significant changes in testicular volume, suggesting the presence of subtle structural alterations. SWE may provide complementary information by detecting changes in testicular parenchymal&#xa0;in patients with varicocele. Des r&#xe9;sultats contradictoires sur la raideur testiculaire en pr&#xe9;sence de varicoc&#xe8;le ainsi que l&#x2019;absence d&#x2019;un protocole de mesure standardis&#xe9; freinent la stadification clinique. Dans la pr&#xe9;sente &#xe9;tude, nous avons cherch&#xe9; &#xe0; &#xe9;tudier les effets de la fr&#xe9;quence de la sonde et de la s&#xe9;lection de la taille de la r&#xe9;gion d&#x2019;int&#xe9;r&#xea;t (ROI) sur les mesures de raideur testiculaire, ainsi qu&#x2019;&#xe0; &#xe9;valuer la raideur et les variations de volume du parenchyme testiculaire chez les patients porteurs de varicoc&#xe8;le par rapport &#xe0; des t&#xe9;moins sains, dans des conditions standardis&#xe9;es. L&#x2019;&#xe9;lastographie par ondes de cisaillement (SWE) a d&#x2019;abord &#xe9;t&#xe9; r&#xe9;alis&#xe9;e sur 62 testicules chez 31 hommes en bonne sant&#xe9;, avec deux fr&#xe9;quences de sonde (SL10&#x2013;2 et SL15&#x2013;4) et quatre tailles de la ROI (4, 6, 8 et 10 mm), afin d&#x2019;&#xe9;valuer l&#x2019;impact sur les mesures par SWE. Sur la base des r&#xe9;glages de variabilit&#xe9; les plus faibles, le volume et la raideur testiculaires ont &#xe9;t&#xe9; compar&#xe9;s chez 76 patients atteints de varicoc&#xe8;les et 68 t&#xe9;moins sains. Diff&#xe9;rentes valeurs de SWE ont &#xe9;t&#xe9; obtenues avec les deux sondes et quatre tailles de ROI (p < 0,05). La sonde SL15&#x2013;4 a montr&#xe9; une variabilit&#xe9; plus faible, avec le coefficient de variation le plus faible pour une ROI de 4 mm. La valeur m&#xe9;diane de SWE testiculaire &#xe9;tait de 2,03 (1,97&#x2013;2,07) kPa dans le groupe t&#xe9;moin et respectivement de 2,01 (1,87&#x2013;2,07), 1,77 (1,53&#x2013;1,98) et 1,51 (1,45&#x2013;1,63) kPa dans les groupes de varicoc&#xe8;les de grade I, II et III. Les valeurs de SWE &#xe9;taient significativement plus faibles chez les patients avec varicoc&#xe8;les et diminuaient avec l&#x2019;augmentation du grade. Les m&#xe9;dianes des volumes testiculaires &#xe9;taient de 13,08 (12,06&#x2013;15,70) mL dans le groupe t&#xe9;moin et respectivement de 12,26 (10,70&#x2013;15,15), 13,06 (11,34&#x2013;14,72) et 11,84 (11,26&#x2013;12,86) mL dans les groupes de varicoc&#xe8;les de grade I, II et III. Aucune diff&#xe9;rence significative de volume testiculaire n&#x2019;a &#xe9;t&#xe9; observ&#xe9;e entre les groupes varicoc&#xe8;le et t&#xe9;moins (p = 0,387). La fr&#xe9;quence de la sonde et la taille de la ROI influencent les mesures de la SWE testiculaire, et la prudence est recommand&#xe9;e lors de la comparaison des r&#xe9;sultats de la SWE. Notre &#xe9;tude a montr&#xe9; que la raideur testiculaire &#xe9;tait diminu&#xe9;e chez les patients porteurs de varicoc&#xe8;le sans changement significatif du volume testiculaire, sugg&#xe9;rant la pr&#xe9;sence de subtiles alt&#xe9;rations structurelles. La SWE peut fournir des informations compl&#xe9;mentaires en d&#xe9;tectant des modifications du parenchyme testiculaire chez les patients avec varicoc&#xe8;le.

BACKGROUND: Transitioning from medical school to clinical practice is critical for recent medical graduates. Ensuring that graduates feel adequately prepared for this transition is essential for delivering high-quality patient care. The newly implemented reformed medical curriculum (comprising 5 years of medical school followed by 2 years of internship, replacing the traditional 6-year school and 1-year internship) at the Faculty of Medicine, Suez Canal University (FOM-SCU), Egypt, seeks to enhance readiness for clinical practice by integrating competency-based education, early clinical exposure, and extended internship training. This study aims to assess the perceived readiness of the first cohort of graduates from this reformed curriculum for clinical practice and to identify areas requiring improvement. METHODS: A cross-sectional, survey-based study was conducted among the first cohort of medical graduates (academic year 2022&#x2013;2023) from the reformed curriculum at FOM-SCU. A validated, self-administered questionnaire was distributed electronically to collect data on graduates&#x2019; perceived readiness across four domains: Communication and Collaboration, Comprehensive Clinical Practice, Clinical Skills and Confidence, and Ethical, Empathetic, and Safe Patient Care. Responses were recorded using a 5-point Likert scale. Two open-ended questions were added to the survey to assess expected challenges and suggestions for enhancements. Descriptive and inferential statistical analyses were performed. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 141 graduates participated (response rate: 66.8%). The mean overall perceived readiness score was 3.79&#x2009;&#xb1;&#x2009;0.64, with Communication and Collaboration rated highest (4.08&#x2009;&#xb1;&#x2009;0.57), reflecting strengths in teamwork and communication. Comprehensive Clinical Practice was rated lowest (3.55&#x2009;&#xb1;&#x2009;0.64), indicating challenges in managing complex cases and administrative tasks. Male graduates reported significantly higher readiness across all domains (p&#x2009;<&#x2009;0.05). Graduates with extra-curricular clinical experience showed higher readiness (p&#x2009;=&#x2009;0.013). CONCLUSIONS: While graduates of the reformed curriculum at FOM-SCU reported moderate preparedness for clinical practice, some areas for improvement were identified in basic medical skills and comprehensive clinical practice, particularly in handling complex medical conditions and administrative responsibilities. Enhancing hands-on training, structured mentorship, and simulation-based learning could improve graduates&#x2019; confidence and competence.

Social media has rapidly evolved into a primary source of health-related information. For men with concerns regarding their sexual health or fertility, consulting the internet is often felt to be an accessible first-step in exploring their symptoms. Medical misinformation and over-generalisation online remain a significant concern amongst medical professionals, particularly in the current social media era of virality and sensationalism. This narrative review aims to explore the growing intersection between social media and andrology, with insights into the current medical media landscape and the opportunity to enhance health promotion. The search strategy applied core search terms central to the scope of the review (such as "social media" and "andrology") in combination with condition-specific terms (such as "erectile dysfunction" or "testosterone") using Boolean operators to identify relevant literature within PubMed, which served as the primary electronic database, as well as online websites and social media platforms. Social media consumption is on the rise, with users consuming over two hours daily on average worldwide. Amongst posts, there has been a shift towards highly engaging short-form video content, which is particularly popular with young adults. Social media algorithms reinforce consumption patterns by continuously delivering content based on user engagement: the more an individual interacts with a topic or creator, the more related content appears, creating a self-sustaining feedback loop; this principle underpins the concept of virality and risks the rapid dissemination of inaccuracies online. Key men's health topics such as infertility, erectile dysfunction, testosterone supplementation and semen retention are popular amongst social media posts, amassing millions-to-billions of views depending on the platform. Amongst these posts, there is a high degree of misinformation. Clinicians should be confident in navigating the possible challenges associated with social media. Whilst the growing presence of urologists online may have the potential to counter health-related misinformation, there are barriers inherent to social media platforms that limit the reach and impact of expert voices at present. To leverage the opportunity that social media offers, urologists are required to modernise their approach to communication in order to ensure that accurate health information is both accessible and engaging. R&#xe9;SUM&#xe9;: CONTEXTE: Les m&#xe9;dias sociaux sont rapidement devenus une source principale d&#x2019;information sur la sant&#xe9;. Pour les hommes qui s&#x2019;inqui&#xe8;tent de leur sant&#xe9; sexuelle ou de leur fertilit&#xe9;, la consultation d&#x2019;Internet est souvent consid&#xe9;r&#xe9;e comme une premi&#xe8;re &#xe9;tape accessible pour explorer leurs sympt&#xf4;mes. La d&#xe9;sinformation m&#xe9;dicale et la g&#xe9;n&#xe9;ralisation excessive en ligne restent une pr&#xe9;occupation majeure chez les professionnels de la sant&#xe9;, en particulier &#xe0; l&#x2019;&#xe8;re actuelle de la viralit&#xe9; et du sensationnalisme sur les r&#xe9;seaux sociaux. Cette revue narrative vise &#xe0; explorer l&#x2019;intersection croissante entre les m&#xe9;dias sociaux et l&#x2019;andrologie, avec un aper&#xe7;u du paysage m&#xe9;diatique m&#xe9;dical actuel et la possibilit&#xe9; d&#x2019;am&#xe9;liorer la promotion de la sant&#xe9;. La strat&#xe9;gie de recherche a appliqu&#xe9; des termes de recherche de base essentiels &#xe0; l&#x2019;objectif de la revue (tels que &#xab; m&#xe9;dias sociaux&#xbb; et &#xab; andrologie&#xbb;) en combinaison avec des termes sp&#xe9;cifiques &#xe0; une affection (tels que &#xab; dysfonction &#xe9;rectile&#xbb; ou &#xab; testost&#xe9;rone&#xbb;) &#xe0; l&#x2019;aide d&#x2019;op&#xe9;rateurs bool&#xe9;ens pour identifier la litt&#xe9;rature pertinente dans PubMed, qui a servi de base de donn&#xe9;es &#xe9;lectronique principale, ainsi que dans les sites Web en ligne et les plateformes de m&#xe9;dias sociaux. R&#xe9;SULTATS : La consommation des m&#xe9;dias sociaux est en hausse, les utilisateurs consommant en moyenne plus de deux heures par jour dans le monde entier. Parmi les publications, il y a eu une &#xe9;volution vers un contenu vid&#xe9;o de courte dur&#xe9;e tr&#xe8;s attrayant, qui est particuli&#xe8;rement populaire aupr&#xe8;s des jeunes adultes. Les algorithmes des m&#xe9;dias sociaux renforcent les modes de consommation en diffusant en permanence du contenu bas&#xe9; sur l&#x2019;engagement des utilisateurs: plus un individu interagit avec un sujet ou un cr&#xe9;ateur, plus le contenu connexe appara&#xee;t, cr&#xe9;ant ainsi une boucle de r&#xe9;troaction auto-entretenue. Ce principe sous-tend la notion de viralit&#xe9; et risque de provoquer une diffusion rapide d&#x2019;inexactitudes en ligne. Les principaux sujets de sant&#xe9; masculine tels que l&#x2019;infertilit&#xe9;, la dysfonction &#xe9;rectile, la suppl&#xe9;mentation en testost&#xe9;rone et la r&#xe9;tention de sperme sont populaires parmi les publications sur les r&#xe9;seaux sociaux, accumulant des millions &#xe0; des milliards de vues selon la plateforme. Parmi ces messages, il y a un haut degr&#xe9; de d&#xe9;sinformation. Les cliniciens doivent &#xea;tre confiants pour naviguer dans les d&#xe9;fis possibles associ&#xe9;s aux m&#xe9;dias sociaux. CONCLUSIONS : Bien que la pr&#xe9;sence croissante des urologues en ligne puisse avoir le potentiel de contrer la d&#xe9;sinformation li&#xe9;e &#xe0; la sant&#xe9;, il existe des obstacles inh&#xe9;rents aux plateformes de m&#xe9;dias sociaux qui limitent la port&#xe9;e et l&#x2019;impact des voix d&#x2019;experts &#xe0; l&#x2019;heure actuelle. Pour tirer parti de l&#x2019;opportunit&#xe9; qu&#x2019;offrent les m&#xe9;dias sociaux, les andrologues/urologues sont tenus de moderniser leur approche de la communication afin de s&#x2019;assurer que des informations de sant&#xe9; pr&#xe9;cises sont &#xe0; la fois accessibles et attrayantes.

Zika virus (ZIKV), a mosquito-borne flavivirus, remains a concern for reproductive health despite the waning of the 2015-2016 epidemic. Unique among arboviruses, ZIKV can be sexually transmitted, with viral RNA persisting in semen beyond the acute phase, posing potential risks to male fertility and assisted reproduction. This narrative review provides clinicians with a contemporary understanding of ZIKV epidemiology, virology, and its implications for male reproductive care. ZIKV transmission has stabilised into low-level endemicity in Central and South America, with Europe reporting sporadic travel-associated cases. Persistence in semen is underpinned by infection of immune-privileged testicular tissues, including Sertoli, Leydig, and germ cells, enabling RNA detection for months post-infection even after systemic symptoms resolve. While replication-competent virus is rarely isolated beyond 4-6 weeks, viral RNA has been detected in semen over 180 days in rare cases. Clinically, ZIKV infection is associated with transient declines in sperm count, motility, and increased DNA fragmentation, likely mediated by inflammation, blood-testis barrier disruption, and impaired testosterone biosynthesis. Human studies suggest recovery of semen quality in most cases, but animal models demonstrate more persistent testicular damage and subfertility, supporting potential long-term reproductive impact. Current WHO guidance recommends a 3-month deferral from conception for men with confirmed or suspected ZIKV exposure. In assisted reproduction, cryopreserved semen from recently exposed individuals may retain viral RNA, requiring stringent handling and closed-system storage. Routine semen PCR testing is not widely adopted due to sensitivity limitations and inability to distinguish infectivity; thus, risk stratification based on travel and exposure history remains central to decision-making. In clinical practice, this risk stratification typically applies to men undergoing fertility assessment with recent travel to ZIKV-endemic regions, particularly in Central or South America, with compatible symptom history or recent onset infertility. ZIKV remains a relevant consideration in andrology and fertility practice, particularly in regions with ongoing endemic transmission and in individuals with travel-related exposure. Awareness of its virological properties, reproductive implications, and guidance for pre-conception counselling, laboratory practice, and semen storage is crucial. With appropriate precautions and patient education, most couples can safely proceed with fertility planning following ZIKV exposure. R&#xe9;SUM&#xe9;: CONTEXTE: Le virus Zika (ZIKV), un flavivirus transmis par les moustiques, reste une source d&#x2019;inqui&#xe9;tude pour la sant&#xe9; reproductive malgr&#xe9; le d&#xe9;clin de l&#x2019;&#xe9;pid&#xe9;mie de 2015-2016. Unique parmi les arbovirus, le ZIKV peut &#xea;tre transmis sexuellement, l&#x2019;ARN viral persistant dans le sperme au-del&#xe0; de la phase aigu&#xeb;, pr&#xe9;sentant de potentiels risques pour la fertilit&#xe9; masculine et la procr&#xe9;ation assist&#xe9;e. La pr&#xe9;sente revue narrative offre aux cliniciens une compr&#xe9;hension contemporaine de l&#x2019;&#xe9;pid&#xe9;miologie du ZIKV, de la virologie du ZIKV, ainsi que de ses implications pour les soins reproductifs masculins. R&#xe9;SULTATS: La transmission du ZIKV s&#x2019;est stabilis&#xe9;e en end&#xe9;micit&#xe9; de faible intensit&#xe9; en Am&#xe9;rique centrale et du Sud, l&#x2019;Europe rapportant des cas sporadiques li&#xe9;s aux voyages. La persistance dans le sperme est soutenue par une infection des tissus testiculaires immunoprivil&#xe9;gi&#xe9;s, notamment des cellules de Sertoli, de Leydig, et des cellules germinales, permettant la d&#xe9;tection d&#x2019;ARN pendant plusieurs mois apr&#xe8;s l&#x2019;infection, m&#xea;me apr&#xe8;s la r&#xe9;solution des sympt&#xf4;mes syst&#xe9;miques. Bien qu&#x2019;un virus comp&#xe9;tent pour la r&#xe9;plication soit rarement isol&#xe9; au-del&#xe0; de 4 &#xe0; 6 semaines, de l&#x2019;ARN viral a &#xe9;t&#xe9; d&#xe9;tect&#xe9; dans le sperme jusqu&#x2019;&#xe0; plus de 180 jours dans de rares cas. Cliniquement, l&#x2019;infection par le ZIKV est associ&#xe9;e &#xe0; des baisses transitoires du nombre de spermatozo&#xef;des, de leur motilit&#xe9;, et d&#x2019;une augmentation de la fragmentation de l&#x2019;ADN, probablement m&#xe9;di&#xe9;es par l&#x2019;inflammation, par la rupture de la barri&#xe8;re sanguin-testicule, et par une biosynth&#xe8;se alt&#xe9;r&#xe9;e de la testost&#xe9;rone. Des &#xe9;tudes humaines sugg&#xe8;rent une r&#xe9;cup&#xe9;ration de la qualit&#xe9; du sperme dans la plupart des cas, mais les mod&#xe8;les animaux montrent des l&#xe9;sions testiculaires et une hypofertilit&#xe9; plus persistantes, ce qui soutient un impact reproductif potentiel &#xe0; long terme. Les recommandations actuelles de l&#x2019;OMS sont de reporter de 3 mois la conception pour les hommes ayant une exposition confirm&#xe9;e ou suspect&#xe9;e au ZIKV. En cas d&#x2019;assistance m&#xe9;dicalis&#xe9;e &#xe0; une procr&#xe9;ation, le sperme cryopr&#xe9;serv&#xe9; provenant d&#x2019;hommes r&#xe9;cemment expos&#xe9;s peut retenir de l&#x2019;ARN viral, n&#xe9;cessitant une manipulation rigoureuse et un stockage du sperme en syst&#xe8;me ferm&#xe9;. Le test PCR de routine du sperme n&#x2019;est pas largement adopt&#xe9; en raison de limitations de sensibilit&#xe9; et de l&#x2019;incapacit&#xe9; &#xe0; distinguer l&#x2019;infectiosit&#xe9; ; ainsi, la stratification du risque bas&#xe9;e sur l&#x2019;historique des voyages et des expositions reste centrale dans la prise de d&#xe9;cision. En pratique clinique, cette stratification du risque s&#x2019;applique g&#xe9;n&#xe9;ralement aux hommes ayant eu une &#xe9;valuation de leur fertilit&#xe9; en raison de voyages r&#xe9;cents dans des r&#xe9;gions end&#xe9;miques du ZIKV, en particulier en Am&#xe9;rique centrale ou du Sud, et qui pr&#xe9;sentent des ant&#xe9;c&#xe9;dents de sympt&#xf4;mes compatibles ou une infertilit&#xe9; &#xe0; d&#xe9;but r&#xe9;cent. CONCLUSIONS: Le ZIKV reste une consid&#xe9;ration pertinente en andrologie et en m&#xe9;decine de la fertilit&#xe9;, en particulier dans les r&#xe9;gions &#xe0; transmission end&#xe9;mique continue et chez les individus &#xe0; risque d&#x2019;exposition li&#xe9;e aux voyages. Une sensibilisation est cruciale &#xe0; ses propri&#xe9;t&#xe9;s virologiques, aux implications reproductives, aux conseils lors de consultations pr&#xe9; conceptionnelles, &#xe0; la pratique en laboratoire, et au stockage du sperme. Avec des pr&#xe9;cautions appropri&#xe9;es et une &#xe9;ducation des patients, la plupart des couples peuvent poursuivre en toute s&#xe9;curit&#xe9; la planification d&#x2019;une grossesse apr&#xe8;s une exposition au ZIKV.

We conducted a double-blind, randomized controlled trial to evaluate the effect of early administration of tadalafil (5&#xa0;mg once daily) on persistent storage lower urinary tract symptoms (LUTS) and erectile function following transurethral resection of the prostate (TURP). All enrolled patients underwent TURP and were randomly assigned to one of two groups: Group A received tadalafil (5&#xa0;mg once daily) postoperatively, while Group B received a placebo. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire, and LUTS were evaluated using the International Prostate Symptom Score (IPSS). The study was conducted at a tertiary care hospital between May 2021 and October 2022. A total of 195 patients were enrolled and randomized into two groups: Group A (n&#x2009;=&#x2009;103), which received tadalafil 5&#xa0;mg once daily, and Group B (n&#x2009;=&#x2009;92), which received a placebo. The mean&#x2009;&#xb1;&#x2009;standard deviation (SD) scores for the International Index of Erectile Function (IIEF-5) in Group A at 1, 3, and 6&#xa0;months post-TURP were 11.59&#x2009;&#xb1;&#x2009;1.90, 19.80&#x2009;&#xb1;&#x2009;1.12, and 20.97&#x2009;&#xb1;&#x2009;0.72, respectively. In Group B, the corresponding scores were 4.88&#x2009;&#xb1;&#x2009;0.82, 12.86&#x2009;&#xb1;&#x2009;1.56, and 15.32&#x2009;&#xb1;&#x2009;1.28. These differences were statistically significant (P&#x2009;<&#x2009;0.001). Similarly, the mean&#x2009;&#xb1;&#x2009;SD values for the International Prostate Symptom Score (IPSS) in Group A at 1, 3, and 6&#xa0;months post-TURP were 7.31&#x2009;&#xb1;&#x2009;1.66, 4.46&#x2009;&#xb1;&#x2009;0.97, and 2.33&#x2009;&#xb1;&#x2009;0.69, respectively, compared to 9.62&#x2009;&#xb1;&#x2009;3.34, 5.40&#x2009;&#xb1;&#x2009;1.98, and 2.83&#x2009;&#xb1;&#x2009;1.27 in Group B (P&#x2009;<&#x2009;0.001). Regarding storage symptom subscores, Group A demonstrated preoperative and postoperative mean&#x2009;&#xb1;&#x2009;SD values of 8.63&#x2009;&#xb1;&#x2009;1.82, 3.05&#x2009;&#xb1;&#x2009;0.78, 1.63&#x2009;&#xb1;&#x2009;0.49, and 0.92&#x2009;&#xb1;&#x2009;0.67 at preoperative, 1, 3, and 6&#xa0;months, respectively. In contrast, Group B showed corresponding values of 3.22&#x2009;&#xb1;&#x2009;0.72, 2.48&#x2009;&#xb1;&#x2009;0.50, and 1.69&#x2009;&#xb1;&#x2009;0.47. These differences were also statistically significant (P&#x2009;<&#x2009;0.001). Tadalafil 5&#xa0;mg daily as monotherapy following TURP can lead to early improvement in erectile function; however, its effect on persistent storage lower urinary tract symptoms (LUTS) post-TURP appears to be modest. Our study has been approved by local ethical committee Kafrelsheikh university(MKSU50-3-1) on 20/5/2021 and by clinical trials (NCT06788704) on 25/1/2025. R&#xe9;SUM&#xe9;: CONTEXTE: Nous avons men&#xe9; un essai contr&#xf4;l&#xe9; randomis&#xe9; en double aveugle pour &#xe9;valuer l&#x2019;effet de l&#x2019;administration pr&#xe9;coce de tadalafil (5 mg une fois par jour) sur les sympt&#xf4;mes persistants des voies urinaires inf&#xe9;rieures (SBAU/LUTS) et la fonction &#xe9;rectile apr&#xe8;s r&#xe9;section transur&#xe9;trale de la prostate (RTUP). Tous les patients recrut&#xe9;s ont subi une RTUP et ont &#xe9;t&#xe9; r&#xe9;partis au hasard dans l&#x2019;un des deux groupes suivants: le groupe A a re&#xe7;u du tadalafil (5 mg une fois par jour) en postop&#xe9;ratoire, tandis que le groupe B a re&#xe7;u un placebo. La fonction &#xe9;rectile a &#xe9;t&#xe9; &#xe9;valu&#xe9;e &#xe0; l&#x2019;aide du questionnaire de l&#x2019;International Index of Erectile Function-5 (IIEF-5), et les LUTS ont &#xe9;t&#xe9; &#xe9;valu&#xe9;s &#xe0; l&#x2019;aide de l&#x2019;International Prostate Symptom Score (IPSS). L&#x2019;&#xe9;tude a &#xe9;t&#xe9; men&#xe9;e dans un h&#xf4;pital de soins tertiaires entre mai 2021 et octobre 2022. R&#xe9;SULTATS: Au total, 195 patients ont &#xe9;t&#xe9; recrut&#xe9;s et r&#xe9;partis al&#xe9;atoirement en deux groupes: le groupe A (n&#x2009;=&#x2009;103) a re&#xe7;u 5 mg de tadalafil une fois par jour, et le groupe B (n&#x2009;=&#x2009;92) a re&#xe7;u un placebo. Les moyennes (&#xb1;&#x2009;SD) des scores de l&#x2019;IIEF-5 dans le groupe A &#xe0; 1, 3 et 6 mois apr&#xe8;s la RTUP &#xe9;taient respectivement de 11,59&#x2009;&#xb1;&#x2009;1,90, 19,80&#x2009;&#xb1;&#x2009;1,12 et de 20,97&#x2009;&#xb1;&#x2009;0,72. Dans le groupe B, les scores correspondants &#xe9;taient de 4,88&#x2009;&#xb1;&#x2009;0,82, 12,86&#x2009;&#xb1;&#x2009;1,56 et 15,32&#x2009;&#xb1;&#x2009;1,28. Ces diff&#xe9;rences &#xe9;taient significatives (P&#x2009;<&#x2009;0,001). De m&#xea;me, les valeurs moyennes (&#xb1;&#x2009;SD) pour l&#x2019;IPSS dans le groupe A &#xe0; 1, 3 et 6 mois apr&#xe8;s la RTUP &#xe9;taient de 7,31&#x2009;&#xb1;&#x2009;1,66, 4,46&#x2009;&#xb1;&#x2009;0,97 et 2,33&#x2009;&#xb1;&#x2009;0,69, respectivement, contre 9,62&#x2009;&#xb1;&#x2009;3,34, 5,40&#x2009;&#xb1;&#x2009;1,98 et 2,83&#x2009;&#xb1;&#x2009;1,27 dans le groupe B (P&#x2009;<&#x2009;0,001). En ce qui concerne les sous-scores des sympt&#xf4;mes de stockage, le groupe A a pr&#xe9;sent&#xe9; des valeurs moyennes (&#xb1;&#x2009;SD) pr&#xe9;op&#xe9;ratoires et postop&#xe9;ratoires de 8,63&#x2009;&#xb1;&#x2009;1,82, 3,05&#x2009;&#xb1;&#x2009;0,78, 1,63&#x2009;&#xb1;&#x2009;0,49 et de 0,92&#x2009;&#xb1;&#x2009;0,67 &#xe0; 1, 3 et 6 mois, respectivement. En revanche, le groupe B a montr&#xe9; des valeurs correspondantes de 3,22&#x2009;&#xb1;&#x2009;0,72, 2,48&#x2009;&#xb1;&#x2009;0,50 et 1,69&#x2009;&#xb1;&#x2009;0,47. Ces diff&#xe9;rences &#xe9;taient &#xe9;galement significatives (P&#x2009;<&#x2009;0,001). CONCLUSION: Le tadalafil 5 mg par jour en monoth&#xe9;rapie apr&#xe8;s RTUP peut entra&#xee;ner une am&#xe9;lioration pr&#xe9;coce de la fonction &#xe9;rectile; cependant, son effet sur les sympt&#xf4;mes persistants des voies urinaires inf&#xe9;rieures (SBAU) apr&#xe8;s la RTUP semble &#xea;tre modeste. MOTS-CL&#xe9;S: Tadalafil 5 mg; LUTS de Stockage; Fonction &#xe9;rectile. ENREGISTREMENT DE L&#x2019;ESSAI: Notre &#xe9;tude a &#xe9;t&#xe9; approuv&#xe9;e par le comit&#xe9; d&#x2019;&#xe9;thique local de l&#x2019;universit&#xe9; Kafrelsheikh (MKSU50-3&#x2013;1) le 20/5/2021 et par les essais cliniques (NCT06788704) le 25/1/2025.

Research on Thyroid function in fertility/infertility has mainly focused on women, while men have scarcely been investigated. We investigated the association between TSH pattern and semen parameters, considering age, BMI, smoking and alcohol drinking. For 2021-2023, we examined all 346 male patients (infertile/fertile) in a Center for Reproductive Medicine at Germany. Age, BMI, smoking and detailed alcohol intake were recorded. A blood sample was taken from each patient in connection with the sperm collection to measure TSH, FSH, LH, prolactin, testosterone levels and the LH to testosterone ratio. Spearman's correlation coefficients were used to determine correlations among hormones. Statistical analyses were performed using semen parameters as dichotomized using world health organization reference values. The analysis explored relationships between age, BMI, smoking, alcohol consumption and semen parameters with TSH levels. The mean age and BMI were 35.8&#x2009;&#xb1;&#x2009;7.43 years and 27.1&#x2009;&#xb1;&#x2009;4.54 kgm-&#x2009;2, respectively. Of all participants, 37% reported being smokers, alcohol consumption was 3% every day, 35% each week, 44% each month and 17% none. For TSH, we recorded 309 TSH levels, and the normal range was given as 0.4 to 4 mIU/L; 95% of the participants were in this category. Only a few participants were outside this range, with 1% below and 4% above. TSH levels were not found to be significantly affected by age, BMI, smoking, alcohol consumption or season. We found a positive correlation between TSH and prolactin (r&#x2009;=&#x2009;0.199, p&#x2009;=&#x2009;0.0001). Logistic regression showed that when TSH values were within the normal range, sperm counts were significantly higher (odds ratio:1.302, P&#x2009;=&#x2009;0.043; confidence interval 95%:1.009-1.681). Male patients with abnormal TSH levels are not very common in this region (5%). Further studies regarding thyroid tests in andrology laboratory are required. TSH assessment in infertile couples should be routine in both partners, given the recorded worldwide increase in thyroid dysfunction. R&#xe9;SUM&#xe9;: CONTEXTE: La recherche sur la fonction thyro&#xef;dienne en fertilit&#xe9;/infertilit&#xe9; s&#x2019;est principalement concentr&#xe9;e sur les femmes, tandis que les hommes ont &#xe9;t&#xe9; rarement &#xe9;tudi&#xe9;s. Nous avons &#xe9;tudi&#xe9; l&#x2019;association entre le sch&#xe9;ma de TSH et les param&#xe8;tres du sperme, en tenant compte de l&#x2019;&#xe2;ge, de l&#x2019;IMC, du tabagisme et de la consommation d&#x2019;alcool. Pendant la p&#xe9;riode 2021 &#x2013; 2023, nous avons examin&#xe9; tous les 346 patients masculins (infertiles/fertiles) dans un Centre de M&#xe9;decine de la Reproduction en Allemagne. L&#x2019;&#xe2;ge, l&#x2019;IMC, le tabagisme et la consommation d&#xe9;taill&#xe9;e d&#x2019;alcool ont &#xe9;t&#xe9; enregistr&#xe9;s. Un &#xe9;chantillon sanguin a &#xe9;t&#xe9; pr&#xe9;lev&#xe9; sur chaque patient en lien avec la collecte de sperme, afin de mesurer les hormones TSH, FSH, LH, prolactine, les niveaux de testost&#xe9;rone et le rapport LH/testost&#xe9;rone. Les coefficients de corr&#xe9;lation de Spearman ont &#xe9;t&#xe9; utilis&#xe9;s pour d&#xe9;terminer les corr&#xe9;lations entre hormones. Des analyses statistiques ont &#xe9;t&#xe9; r&#xe9;alis&#xe9;es en utilisant les param&#xe8;tres du sperme dichotomis&#xe9;s &#xe0; partir des valeurs de r&#xe9;f&#xe9;rence de l&#x2019;Organisation Mondiale de la Sant&#xe9;. R&#xe9;SULTATS: L&#x2019;analyse a explor&#xe9; les relations entre l&#x2019;&#xe2;ge, l&#x2019;IMC, le tabagisme, la consommation d&#x2019;alcool et les param&#xe8;tres du sperme avec les niveaux de TSH. Les valeurs moyennes de l&#x2019;&#xe2;ge et l&#x2019;IMC &#xe9;taient respectivement de 35,8 &#xb1; 7,4 ans et 27,1 &#xb1; 4,5 kgm-2. Parmi tous les participants, 37% ont d&#xe9;clar&#xe9; fumer, la consommation d&#x2019;alcool &#xe9;tait de 3% chaque jour, 35% chaque semaine, 44% chaque mois et aucune chez 17%. Pour la TSH, nous avons enregistr&#xe9; 309 taux de TSH, et la plage normale &#xe9;tait donn&#xe9;e entre 0,4 et 4 mIU/L ; 95% des participants appartenaient &#xe0; cette cat&#xe9;gorie. Seuls quelques participants &#xe9;taient en dehors de cette fourchette, avec 1% en dessous et 4% au-dessus. Les niveaux de TSH n&#x2019;&#xe9;taient pas significativement affect&#xe9;s par l&#x2019;&#xe2;ge, l&#x2019;IMC, le tabagisme, la consommation d&#x2019;alcool ou la saison. Nous avons trouv&#xe9; une corr&#xe9;lation positive entre la TSH et la prolactine (r = 0,199, p = 0,0001). CONCLUSIONS: Les patients masculins pr&#xe9;sentant des taux anormaux de TSH sont peu fr&#xe9;quents dans cette r&#xe9;gion (5%). Des &#xe9;tudes suppl&#xe9;mentaires concernant les tests thyro&#xef;diens en laboratoire d&#x2019;Andrologie sont n&#xe9;cessaires. L&#x2019;&#xe9;valuation de la TSH chez les couples infertiles devrait &#xea;tre courante chez les deux partenaires, compte tenu de l&#x2019;augmentation mondiale des dysfonctionnements thyro&#xef;diens.

Male-factor infertility contributes substantially to the burden of infertility, yet evidence on semen abnormalities and their associated factors in Uganda remains limited. This study assessed the prevalence, patterns, and factors associated with abnormal semen values among men seeking fertility services in Eastern and Central Uganda. A cross-sectional study was conducted among 155 men attending Jinja Regional Referral Hospital, Kayunga Regional Referral Hospital, and Healingway Diagnostic and Fertility Centre between September 2025 and January 2026. Semen analysis was performed using World Health Organization criteria. Factors associated with abnormal semen values were assessed using bivariable and multivariable logistic regression analyses. Overall, 52 of 155 participants had at least one abnormal semen parameter, giving a prevalence of 33.5% (95% CI: 26.5-41.4). The prevalence did not differ significantly across study sites (p&#x2009;=&#x2009;0.841). Teratozoospermia (42.3%) and asthenozoospermia (38.5%) were the most common abnormalities, followed by hypospermia (26.9%), necrozoospermia (25.0%), oligozoospermia (23.1%), and azoospermia (23.1%). Hypertension (AOR&#x2009;=&#x2009;5.23; 95% CI: 1.10-24.93), diabetes mellitus (AOR&#x2009;=&#x2009;4.82; 95% CI: 1.85-12.57), medication use (AOR&#x2009;=&#x2009;2.73; 95% CI: 1.11-6.71), history of mumps infection (AOR&#x2009;=&#x2009;5.29; 95% CI: 1.25-22.31), and occupational hazard exposure (AOR&#x2009;=&#x2009;4.23; 95% CI: 1.60-11.13) were independently associated with abnormal semen parameters. Approximately one in three men seeking fertility services in Eastern and Central Uganda had at least one abnormal semen parameter, with abnormalities in sperm morphology and motility being the most common findings. Hypertension, diabetes mellitus, medication use, history of mumps infection, and occupational hazard exposure were associated with abnormal semen parameters. Assessment of medical conditions, previous infections, medication use, and occupational exposures may therefore be useful when evaluating men presenting with infertility. R&#xe9;SUM&#xe9;: CONTEXTE: L&#x2019;infertilit&#xe9; masculine contribue de mani&#xe8;re substantielle au fardeau de l&#x2019;infertilit&#xe9;&#xa0;; pourtant les preuves concernant les anomalies du sperme et leurs facteurs associ&#xe9;s en Ouganda restent limit&#xe9;es. Cette &#xe9;tude a &#xe9;valu&#xe9; la pr&#xe9;valence, les profils et les facteurs associ&#xe9;s &#xe0; des valeurs anormales de sperme chez les hommes &#xe0; la recherche de services de fertilit&#xe9; dans l&#x2019;Est et le Centre de l&#x2019;Ouganda. Une &#xe9;tude transversale a &#xe9;t&#xe9; r&#xe9;alis&#xe9;e aupr&#xe8;s de 155 hommes se pr&#xe9;sentant &#xe0; l&#x2019;h&#xf4;pital de r&#xe9;f&#xe9;rence r&#xe9;gional Jinja, &#xe0; l&#x2019;h&#xf4;pital r&#xe9;gional de r&#xe9;f&#xe9;rence de Kayunga et au centre de diagnostic et de fertilit&#xe9; de Healingway entre septembre 2025 et janvier 2026. L&#x2019;analyse du sperme a &#xe9;t&#xe9; r&#xe9;alis&#xe9;e selon les crit&#xe8;res de l&#x2019;Organisation mondiale de la sant&#xe9;. Les facteurs associ&#xe9;s &#xe0; des valeurs anormales des param&#xe8;tres spermatiques ont &#xe9;t&#xe9; &#xe9;valu&#xe9;s &#xe0; l&#x2019;aide d&#x2019;analyses de r&#xe9;gressions logistiques bivariables et multivariables. R&#xe9;SULTATS: Au total, 52 participants sur 155 pr&#xe9;sentaient au moins un param&#xe8;tre du sperme anormal, soit une pr&#xe9;valence de 33,5 % (IC &#xe0; 95 % : 26,5&#x2013;41,4). La pr&#xe9;valence n&#x2019;a pas diff&#xe9;r&#xe9; significativement selon les sites d&#x2019;&#xe9;tude (p = 0,841). La t&#xe9;ratozoospermie (42,3 %) et l&#x2019;asth&#xe9;nozoospermie (38,5 %) &#xe9;taient les anomalies les plus courantes, suivies par l&#x2019;hypospermie (26,9 %), la n&#xe9;crozoospermie (25,0 %), l&#x2019;oligozoospermie (23,1 %) et l&#x2019;azoospermie (23,1 %). L&#x2019;hypertension (AOR = 5,23 ; IC 95 % : 1,10&#x2013;24,93), le diab&#xe8;te sucr&#xe9; (AOR = 4,82 ; IC 95 % : 1,85&#x2013;12,57), l&#x2019;utilisation de m&#xe9;dicaments (AOR = 2,73 ; IC 95 % : 1,11&#x2013;6,71), les ant&#xe9;c&#xe9;dents d&#x2019;orchites ourliennes (AOR = 5,29 ; IC 95 % : 1,25&#x2013;22,31) et l&#x2019;exposition aux risques professionnels (AOR = 4,23 ; IC 95 % : 1,60&#x2013;11,13) &#xe9;taient ind&#xe9;pendamment associ&#xe9;s &#xe0; des param&#xe8;tres anormaux du sperme. CONCLUSIONS: Environ un homme sur trois consultant des services de fertilit&#xe9; dans l&#x2019;Est et le Centre de l&#x2019;Ouganda pr&#xe9;sentait au moins un param&#xe8;tre du sperme anormal, les anomalies de morphologie et de motilit&#xe9; des spermatozo&#xef;des &#xe9;tant les r&#xe9;sultats les plus courants. L&#x2019;hypertension, le diab&#xe8;te sucr&#xe9;, la consommation de m&#xe9;dicaments, les ant&#xe9;c&#xe9;dents d&#x2019;orchites ourliennes et l&#x2019;exposition aux risques professionnels &#xe9;taient associ&#xe9;s &#xe0; des param&#xe8;tres anormaux du sperme. L&#x2019;&#xe9;valuation des conditions m&#xe9;dicales, des infections ant&#xe9;rieures, de l&#x2019;utilisation de m&#xe9;dicaments et des expositions professionnelles peuvent donc &#xea;tre utiles lors de l&#x2019;&#xe9;valuation des hommes pr&#xe9;sentant une infertilit&#xe9;.

BACKGROUND: Male reproductive dysfunction has been reported during the acute phase of COVID-19. However, the long-term patterns in semen quality and hormonal parameters across the extended pandemic and post-pandemic periods, and whether these patterns differ by age, remain poorly characterized. This large-scale, retrospective study was conducted to delineate these trajectories in infertile men. RESULTS: Among 90,125 records, normal sperm morphology showed a sustained deficit: the proportion of men with morphology&#x2009;&#x2265;&#x2009;4% declined from 88.9% pre-pandemic to 55.1% in Post-Phase 2 (p&#x2009;<&#x2009;0.001), with nearly half falling below the WHO clinical threshold (4%). Serum testosterone decreased modestly from 4.46 to 4.19 ng/mL (6.1% reduction; (p&#x2009;=&#x2009;0.006) but remained above the hypogonadism threshold for most men. These alterations persisted two years into the post-pandemic period without returning to pre-pandemic baselines. CONCLUSIONS: The COVID-19 pandemic was associated with persistent, clinically meaningful deficits in normal sperm morphology and a moderate, non-hypogonadal testosterone suppression, with distinct age-dependent patterns. These findings underscore the need for age-stratified reproductive health surveillance following major population-level stressors. Un dysfonctionnement reproductif masculin a &#xe9;t&#xe9; signal&#xe9; durant la phase aigu&#xeb; du COVID-19. Cependant, les tendances &#xe0; long terme de la qualit&#xe9; du sperme et des param&#xe8;tres hormonaux &#xe0; travers les p&#xe9;riodes prolong&#xe9;es de pand&#xe9;mie et de postpand&#xe9;mie, ainsi que la diff&#xe9;rence de ces tendances selon l&#x2019;&#xe2;ge, restent peu caract&#xe9;ris&#xe9;es. Cette &#xe9;tude r&#xe9;trospective &#xe0; grande &#xe9;chelle a &#xe9;t&#xe9; men&#xe9;e pour d&#xe9;limiter ces trajectoires chez les hommes infertiles. Parmi 90 125 dossiers, la morphologie normale des spermatozo&#xef;des a montr&#xe9; un d&#xe9;ficit soutenu : la proportion d&#x2019;hommes avec une morphologie &#x2265;4 % est pass&#xe9;e de 88,9 % avant la pand&#xe9;mie &#xe0; 55,1 % en post-phase 2 (p < 0,001), pr&#xe8;s de la moiti&#xe9; se situant en dessous du seuil clinique de l&#x2019;OMS (4 %). La testost&#xe9;rone s&#xe9;rique a l&#xe9;g&#xe8;rement diminu&#xe9; de 4,46 &#xe0; 4,19 ng/mL (r&#xe9;duction de 6,1 % ; p = 0,006), mais elle restait au-dessus du seuil d&#x2019;hypogonadisme chez la plupart des hommes. Ces modifications ont persist&#xe9; deux ans apr&#xe8;s le d&#xe9;but de la p&#xe9;riode postpand&#xe9;mique sans revenir aux niveaux de base d&#x2019;avant la pand&#xe9;mie. La pand&#xe9;mie de COVID-19 a &#xe9;t&#xe9; associ&#xe9;e &#xe0; des d&#xe9;ficits persistants et cliniquement significatifs de la morphologie normale des spermatozo&#xef;des ainsi qu&#x2019;&#xe0; une suppression mod&#xe9;r&#xe9;e de la testost&#xe9;rone, mais non hypogonadique, avec des sch&#xe9;mas distincts en fonction de l&#x2019;&#xe2;ge. Ces r&#xe9;sultats soulignent la n&#xe9;cessit&#xe9; d&#x2019;une surveillance de la sant&#xe9; reproductive stratifi&#xe9;e par &#xe2;ge &#xe0; la suite des principaux facteurs de stress au niveau de la population.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women with potential familial and genetic components. Emerging evidence suggests that male first-degree relatives (fathers and brothers) may exhibit endocrine and metabolic abnormalities similar to a "male equivalent" of PCOS, although the condition remains without clear diagnostic criteria. We conducted a systematic review and meta-analysis to investigate whether male relatives of women with PCOS show consistent patterns of metabolic and hormonal dysregulation. A total of 21 studies met inclusion criteria, encompassing male first-degree relatives of women with PCOS with available data on metabolic, hormonal, and cardiovascular outcomes. Meta-analysis showed that male relatives had significantly higher fasting blood glucose (MD: 6.25; 95% CI: 1.36-11.14), body mass index (1.18; 0.35-2.02), triglycerides (17.82; 10.82-24.81), total cholesterol (18.63; 6.16-31.10), LDL-cholesterol (12.99; 1.27-24.71), and dehydroepiandrosterone sulfate (1.29; 0.66-1.92) compared with controls. They also exhibited higher prevalence of hypertension (OR: 1.88; 1.18-2.29), waist circumference&#x2009;>&#x2009;90 cm (3.27; 1.18-9.08), and androgenetic alopecia (1.65; 1.04-2.60). Findings were consistent across studies, with low to moderate heterogeneity and minimal publication bias. Male first-degree relatives of women with PCOS demonstrate increased rates of metabolic abnormalities, hormonal imbalances, and androgenic features, supporting the concept of a male PCOS of equivalent. These findings underscore the familial nature of PCOS and highlight the need for improved diagnostic criteria and higher clinical awareness. Screening male relatives for metabolic and hormonal risk factors may help identify at-risk individuals and inform preventive interventions. IR.SBMU.ENDOCRINE.REC.1403.146. R&#xe9;SUM&#xe9;: CONTEXTE: Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien courant chez les femmes avec des composantes familiales et g&#xe9;n&#xe9;tiques potentielles. De nouvelles donn&#xe9;es sugg&#xe8;rent que les parents masculins au premier degr&#xe9; (p&#xe8;res et fr&#xe8;res) peuvent pr&#xe9;senter des anomalies endocriniennes et m&#xe9;taboliques similaires &#xe0; un &#xab; &#xe9;quivalent masculin &#xbb; de SOPK, bien que la maladie reste sans crit&#xe8;res diagnostiques clairs. Nous avons r&#xe9;alis&#xe9; une revue syst&#xe9;matique et une m&#xe9;ta-analyse pour d&#xe9;terminer si les parents masculins des femmes atteintes de SOPK pr&#xe9;sentaient des profiles coh&#xe9;rents de d&#xe9;r&#xe9;gulation m&#xe9;tabolique et hormonale. R&#xe9;SULTATS: &#xa0;Au total, 21 &#xe9;tudes r&#xe9;pondaient aux crit&#xe8;res d&#x2019;inclusion, &#xe0; savoir des parents masculins au premier degr&#xe9; de femmes atteintes du SOPK avec des donn&#xe9;es disponibles sur les r&#xe9;sultats m&#xe9;taboliques, hormonaux et cardiovasculaires. La m&#xe9;ta-analyse a montr&#xe9; que les parents masculins avaient une glyc&#xe9;mie &#xe0; jeun significativement plus &#xe9;lev&#xe9;e (Diff&#xe9;rence de Moyennes&#xa0;: 6,25 ; IC95 % : 1,36-11,14), un indice de masse corporelle (1,18 ; 0,35-2,02), des triglyc&#xe9;rides (17,82 ; 10,82 &#xe0; 24,81), un cholest&#xe9;rol total (18,63 ; 6,16 &#xe0; 31,10), un cholest&#xe9;rol LDL (12,99 ; 1,27 &#xe0; 24,71) et le sulfate de d&#xe9;hydro&#xe9;piandrost&#xe9;rone (1,29 ; 0,66 &#xe0; 1,92) que les t&#xe9;moins. Ils pr&#xe9;sentaient &#xe9;galement une pr&#xe9;valence plus &#xe9;lev&#xe9;e d&#x2019;hypertension (OR : 1,88 ; 1,18-2,29), de tour de taille >90 cm (3,27 ; 1,18-9,08) et d&#x2019;alop&#xe9;cie androg&#xe9;nique (1,65 ; 1,04-2,60). Les r&#xe9;sultats &#xe9;taient coh&#xe9;rents d&#x2019;une &#xe9;tude &#xe0; l&#x2019;autre, avec une h&#xe9;t&#xe9;rog&#xe9;n&#xe9;it&#xe9; faible &#xe0; mod&#xe9;r&#xe9;e et un biais de publication minimal. CONCLUSIONS: Les parents masculins au premier degr&#xe9; des femmes atteintes de SOPK pr&#xe9;sentent des taux accrus d&#x2019;anomalies m&#xe9;taboliques, de d&#xe9;s&#xe9;quilibres hormonaux et de caract&#xe9;ristiques androg&#xe9;niques, ce qui soutient le concept d&#x2019;un &#xe9;quivalent masculin de SOPK. Ces r&#xe9;sultats soulignent la nature familiale du SOPK, et font ressortir la n&#xe9;cessit&#xe9; d&#x2019;am&#xe9;liorer les crit&#xe8;res de diagnostic et celle d&#x2019;accro&#xee;tre la sensibilisation clinique. Le d&#xe9;pistage des facteurs de risque m&#xe9;taboliques et hormonaux chez les parents masculins peut aider &#xe0; identifier les personnes &#xe0; risque et &#xe0; les informer sur les interventions pr&#xe9;ventives. NUM&#xe9;RO ID DE L&#x2019;ESSAI : IR.SBMU.ENDOCRINE.REC.1403.146.

Elaboration of alternative therapeutic modality is needed, which should be safer, less costly and with no side effects. Functional Magnetic Stimulator (FMS) is a technique that was approved by the US Food and Drug Administration in 1998. We aimed to evaluate the efficacy of FMS in treating different causes of erectile dysfunction (ED). The mean baseline 15 items of the international index of erectile function (IIEF-15) scores of groups A (arteriogenic ED), B (veno-occlusive ED) and C (psychogenic ED) were 12.8&#x2009;&#xb1;&#x2009;2.6, 16.2&#x2009;&#xb1;&#x2009;3.3 and 27.5&#x2009;&#xb1;&#x2009;3.7, respectively. The mean post sessions IIEF-15 scores of groups A, B and C were 23.4&#x2009;&#xb1;&#x2009;4.1, 31.5&#x2009;&#xb1;&#x2009;3.5, 49.2&#x2009;&#xb1;&#x2009;3.5, respectively. The mean baseline domains of erectile function (EF) scores of groups A, B and C were 3.8&#x2009;&#xb1;&#x2009;2, 5.8&#x2009;&#xb1;&#x2009;3.5 and 11.5&#x2009;&#xb1;&#x2009;3.1, respectively. The mean post sessions domains of EF scores of groups A, B and C were 10.6&#x2009;&#xb1;&#x2009;3.1, 15&#x2009;&#xb1;&#x2009;3.6 and 24.8&#x2009;&#xb1;&#x2009;2.9, respectively. The mean baseline domains of orgasmic function scores of groups A, B and C were 3.3&#x2009;&#xb1;&#x2009;0.9, 3.9&#x2009;&#xb1;&#x2009;0.5 and 4.8&#x2009;&#xb1;&#x2009;0.4, respectively. The mean post sessions domains of orgasmic function scores of groups A, B and C were 4.8&#x2009;&#xb1;&#x2009;0.8 5.9&#x2009;&#xb1;&#x2009;1.0 and 8.6&#x2009;&#xb1;&#x2009;0.5, respectively. The mean baseline domains of sexual desire scores of groups A, B and C were 2.6&#x2009;&#xb1;&#x2009;0.6, 3.1&#x2009;&#xb1;&#x2009;0.7 and 4.8&#x2009;&#xb1;&#x2009;0.7, respectively. The mean post sessions domains of sexual desire scores of groups A, B and C were 3.6&#x2009;&#xb1;&#x2009;0.5, 4.4&#x2009;&#xb1;&#x2009;0.7 and 6.6&#x2009;&#xb1;&#x2009;0.6, respectively. The mean baseline domains of intercourse satisfaction scores of groups A, B and C were 1.9&#x2009;&#xb1;&#x2009;0.5, 2.4&#x2009;&#xb1;&#x2009;0.6 and 4.1&#x2009;&#xb1;&#x2009;0.6, respectively. The mean post sessions domains of intercourse satisfaction scores of groups A, B and C were 2.6&#x2009;&#xb1;&#x2009;0.5, 3.6&#x2009;&#xb1;&#x2009;0.5 and 5.5&#x2009;&#xb1;&#x2009;0.6, respectively. The baseline domains of overall satisfaction scores of groups A, B and C were 1.1&#x2009;&#xb1;&#x2009;0.3, 1.1&#x2009;&#xb1;&#x2009;0.3 and 2.4&#x2009;&#xb1;&#x2009;0.7, respectively. The mean post sessions domains of overall satisfaction scores of groups A, B and C were 2&#x2009;&#xb1;&#x2009;0.7, 2.7&#x2009;&#xb1;&#x2009;0.7 and 3.8&#x2009;&#xb1;&#x2009;0.7, respectively. All patients showed significant improvement regarding domains of the IIEF-15 especially psychogenic cases following the sessions of FMS. Future studies should demonstrate the impact of these sessions on the response of poor responders to phosphodiesterase inhibitors and intracorporeal injections. R&#xe9;SUM&#xe9;: CONTEXTE: L&#x2019;&#xe9;laboration d&#x2019;une modalit&#xe9; th&#xe9;rapeutique alternative est n&#xe9;cessaire, qui devrait &#xea;tre plus s&#xfb;re, moins co&#xfb;teuse et sans effets secondaires. Le stimulateur magn&#xe9;tique fonctionnel (SMF) est une technique qui a &#xe9;t&#xe9; approuv&#xe9;e par la Food and Drug Administration des &#xc9;tats-Unis en 1998. Notre objectif &#xe9;tait d&#x2019;&#xe9;valuer l&#x2019;efficacit&#xe9; du FMS dans le traitement de diff&#xe9;rentes causes de dysfonction &#xe9;rectile (DE). R&#xe9;SULTATS: La moyenne de base de l&#x2019;indice international de la fonction &#xe9;rectile (IIEF-15) des 15 &#xe9;l&#xe9;ments dans les groupes A (DE art&#xe9;riog&#xe8;ne), B (DE veino-occlusif) et C (DE psychog&#xe8;ne) &#xe9;tait respectivement de 12,8&#xb1;2,6, 16,2&#xb1; 3,3 et 27,5&#xb1;3,7. La moyenne des scores de l&#x2019;IIEF-15 apr&#xe8;s les s&#xe9;ances des groupes A, B et C &#xe9;tait respectivement de 23,4&#xb1;4,1, 31,5&#xb1;3,5 et 49,2&#xb1;3,5. La moyenne des scores de base de la fonction &#xe9;rectile (FE) dans les groupes A, B et C &#xe9;tait de 3,8&#xb1; 2, 5,8&#xb1;3,5 et 11,5&#xb1;3,1 respectivement. La moyenne des scores de la FE apr&#xe8;s les s&#xe9;ances &#xe9;tait dans les groupes A, B et C respectivement de 10,6&#xb1;3,1, 15&#xb1;3,6 et 24,8&#xb1;2,9. La moyenne des scores de base des domaines de la fonction orgasmique &#xe9;tait respectivement dans les groupes A, B et C de 3,3&#xb1;0,9, 3,9&#xb1;0,5 et 4,8&#xb1;0,4. La moyenne des scores des domaines de la fonction orgasmique apr&#xe8;s les s&#xe9;ances &#xe9;tait respectivement dans les groupes A, B et C de 4,8&#xb1;0,8, 5,9&#xb1;1,0 et 8,6&#xb1;0,5. La moyenne des scores de base des domaines du d&#xe9;sir sexuel des groupes A, B et C &#xe9;tait de 2,6&#xb1;0,6, 3,1&#xb1;0,7 et 4,8&#xb1;0,7, respectivement. La moyenne des scores des domaines du d&#xe9;sir sexuel apr&#xe8;s les s&#xe9;ances &#xe9;tait respectivement dans les groupes A, B et C de 3,6&#xb1;0,5, 4,4&#xb1;0,7 et 6,6&#xb1;0,6. La moyenne des scores de base des domaines de la satisfaction sexuelle dans les groupes A, B et C &#xe9;tait de 1,9&#xb1;0,5, 2,4&#xb1;0,6 et 4,1&#xb1;0,6, respectivement. La moyenne des scores des domaines de la satisfaction sexuelle apr&#xe8;s les s&#xe9;ances &#xe9;tait respectivement dans les groupes A, B et C de 2,6&#xb1;0,5, 3,6&#xb1;0,5 et 5,5&#xb1;0,6. La moyenne des scores de base des domaines de r&#xe9;f&#xe9;rence de la satisfaction globale des groupes A, B et C &#xe9;tait respectivement de 1,1&#xb1;0,3, 1,1&#xb1;0,3 et 2,4&#xb1;0,7. La moyenne des scores des domaines de r&#xe9;f&#xe9;rence de la satisfaction globale apr&#xe8;s les s&#xe9;ances des groupes A, B et C &#xe9;tait respectivement de &#xa0;2&#xb1;0,7, 2,7&#xb1;0,7 et 3,8&#xb1;0,7. CONCLUSIONS: Tous les patients ont montr&#xe9; une am&#xe9;lioration significative en ce qui concerne les domaines de l&#x2019;IIEF-15, en particulier les cas psychog&#xe8;nes, apr&#xe8;s les s&#xe9;ances de FMS. De futures &#xe9;tudes devraient d&#xe9;montrer l&#x2019;impact de ces s&#xe9;ances sur la r&#xe9;ponse des hommes peu r&#xe9;pondeurs aux inhibiteurs de la phosphodiest&#xe9;rase et aux injections intracorporelles.

Smoking impairs spermatogenesis by disrupting gene and miRNA expression profiles. This study aims to explore the protective effects of quercetin against nicotine-induced testicular damage, with a specific focus on its regulatory role on sperm miR-151a-5p and testicular Cep72 gene expression, as potential molecular mechanisms involved in male reproductive dysfunction. Male BALB/c mice (N&#x2009;=&#x2009;32) were randomly divided into four groups of: control, nicotine, quercetin, and quercetin&#x2009;+&#x2009;nicotine combined groups. Treatments lasted 35 days. Spermatogenesis was evaluated through histopathological studies of the testicles. TAC and SOD levels were evaluated as markers of antioxidant activity using colorimetric methods in testicular homogenates. Sex hormones were measured using the ELISA method. Relative expression of Cep72 and miR-151a-5p genes in testicular tissue and epididymal sperm was assessed by real-time PCR. Androgen receptor (AR) and estrogen receptor alpha (ER&#x3b1;) expression in testicular tissue were evaluated by immunohistochemical methods. The combined treatment of quercetin and nicotine enhanced sperm quality, caused significant changes in LH and estradiol hormone levels, increased anti-oxidants in testicular homogenates, and increased AR expression in Sertoli cells without affecting ER&#x3b1;, compared to the nicotine group. In addition, the combined therapy improved spermatogenesis by increasing the number of germ cells and Leydig cells. Furthermore, combined therapy increased testicular Cep72 gene expression and reduced sperm miR-151a-5p. This study demonstrates that quercetin may protect against nicotine-induced testicular damage by maintaining hormonal balance, enhancing AR expression, improving antioxidant enzyme activity, and normalizing the miR-151a-5p/Cep72 regulatory axis, ultimately supporting sperm quality and spermatogenesis. These results establish a foundation for future mechanistic and translational research. R&#xe9;SUM&#xe9;: CONTEXTE: Le tabagisme alt&#xe8;re la spermatogen&#xe8;se en perturbant les profils d&#x2019;expression des g&#xe8;nes et des miARN. Cette &#xe9;tude vise &#xe0; explorer les effets protecteurs de la querc&#xe9;tine contre les l&#xe9;sions testiculaires induites par la nicotine, en mettant l&#x2019;accent sur son r&#xf4;le r&#xe9;gulateur sur l&#x2019;expression du g&#xe8;ne miR-151a-5p des spermatozo&#xef;des et du g&#xe8;ne Cep72 testiculaires, en tant que m&#xe9;canismes mol&#xe9;culaires potentiels impliqu&#xe9;s dans le dysfonctionnement reproductif masculin. Des souris m&#xe2;les BALB/c (n&#x2009;=&#x2009;32) ont &#xe9;t&#xe9; r&#xe9;parties au hasard en quatre groupes: groupe t&#xe9;moin, groupe nicotine, groupe querc&#xe9;tine et groupe combin&#xe9; querc&#xe9;tine&#x2009;+&#x2009;nicotine. Les traitements ont dur&#xe9; 35 jours. La spermatogen&#xe8;se a &#xe9;t&#xe9; &#xe9;valu&#xe9;e par des &#xe9;tudes histopathologiques des testicules. Les niveaux de TAC et de SOD ont &#xe9;t&#xe9; &#xe9;valu&#xe9;s en tant que marqueurs de l&#x2019;activit&#xe9; antioxydante &#xe0; l&#x2019;aide de m&#xe9;thodes colorim&#xe9;triques dans les homog&#xe9;nats testiculaires. Les hormones sexuelles ont &#xe9;t&#xe9; mesur&#xe9;es par ELISA. L&#x2019;expression relative des g&#xe8;nes Cep72 et miR-151a-5p dans le tissu testiculaire et les spermatozo&#xef;des &#xe9;pididymaires a &#xe9;t&#xe9; &#xe9;valu&#xe9;e par PCR en temps r&#xe9;el. L&#x2019;expression des r&#xe9;cepteurs aux androg&#xe8;nes (RA) et des r&#xe9;cepteurs alpha aux &#x153;strog&#xe8;nes (RE&#x3b1;) dans le tissu testiculaire a &#xe9;t&#xe9; &#xe9;valu&#xe9;e par m&#xe9;thodes immunohistochimiques. R&#xe9;SULTATS: Le traitement combin&#xe9; querc&#xe9;tine&#x2009;+&#x2009;nicotine a am&#xe9;lior&#xe9; la qualit&#xe9; des spermatozo&#xef;des, provoqu&#xe9; des changements significatifs dans les niveaux de LH et d&#x2019;&#x153;stradiol, augment&#xe9; les antioxydants dans les homog&#xe9;nats testiculaires et augment&#xe9; l&#x2019;expression du RA dans les cellules de Sertoli sans affecter RE&#x3b1;, par rapport au groupe nicotine. De plus, la th&#xe9;rapie combin&#xe9;e a am&#xe9;lior&#xe9; la spermatogen&#xe8;se en augmentant le nombre de cellules germinales et de cellules de Leydig. En outre, la th&#xe9;rapie combin&#xe9;e a augment&#xe9; l&#x2019;expression du g&#xe8;ne Cep72 testiculaire et r&#xe9;duit le miR-151a-5p des spermatozo&#xef;des. CONCLUSIONS: Cette &#xe9;tude montre que la querc&#xe9;tine peut prot&#xe9;ger contre les dommages testiculaires induits par la nicotine en maintenant l&#x2019;&#xe9;quilibre hormonal, en am&#xe9;liorant l&#x2019;expression du RA, en am&#xe9;liorant l&#x2019;activit&#xe9; enzymatique antioxydante et en normalisant l&#x2019;axe r&#xe9;gulateur miR-151a-5p/Cep72, favorisant ainsi la qualit&#xe9; des spermatozo&#xef;des et la spermatogen&#xe8;se. Ces r&#xe9;sultats jettent les bases de futures recherches m&#xe9;canistes et translationnelles.

Male infertility affects approximately 10% of men globally, yet approximately 70% of cases lack a definitive genetic diagnosis. Next-generation sequencing has identified numerous monogenic causes, many of which are linked to broader systemic conditions. We curated a list of 596 candidate genes associated with male infertility from the literature and clinical genetics panels. Gene set enrichment analyses were performed on the strong-evidence genes using g: Profiler, REVIGO, and PANTHER to identify overrepresented Gene Ontology (GO) terms, and Reactome pathways. Gene-tissue expression profiles were assessed using GTExv8. Among the 178 strong-evidence genes, enrichment analyses revealed significant overrepresentation of terms related to ciliary and flagellar function (e.g., cilium movement, dynein complex), endocrine signaling (e.g., hormone receptor binding, steroid biosynthesis), and DNA repair mechanisms, particularly the Fanconi anemia nuclear complex. Reactome pathway analysis identified overrepresentation of androgen, glucocorticoid, and mineralocorticoid biosynthesis, BBSome-mediated ciliary transport, and meiosis. Tissue expression clustering identified extra-gonadal expression patterns, implicating adrenal, hypothalamic, and systemic involvement in genetic forms of male infertility. Our gene set enrichment and tissue expression analyses suggest that monogenic causes of male infertility are enriched in pathways in ciliary motility, endocrine regulation, and DNA repair which also have roles in extra-gonadal organ systems. These findings are consistent with epidemiological observations linking male infertility to broader health conditions and support multidisciplinary evaluation and care for affected individuals. R&#xe9;SUM&#xe9;: CONTEXTE: L&#x2019;infertilit&#xe9; masculine touche environ 10 % des hommes dans le Monde, pourtant environ 70 % des cas ne pr&#xe9;sentent pas de diagnostic g&#xe9;n&#xe9;tique d&#xe9;finitif. Le s&#xe9;quen&#xe7;age de nouvelle g&#xe9;n&#xe9;ration a identifi&#xe9; de nombreuses causes monog&#xe9;niques, dont beaucoup sont li&#xe9;es &#xe0; des conditions syst&#xe9;miques plus larges. Nous avons s&#xe9;lectionn&#xe9; une liste de 596 g&#xe8;nes candidats associ&#xe9;s &#xe0; l&#x2019;infertilit&#xe9; masculine &#xe0; partir de la litt&#xe9;rature et des panels de g&#xe9;n&#xe9;tique clinique. Des analyses d&#x2019;enrichissement de l&#x2019;ensemble g&#xe9;n&#xe9;tique ont &#xe9;t&#xe9; r&#xe9;alis&#xe9;es sur les g&#xe8;nes &#xe0; forte preuve en utilisant Profiler, REVIGO et PANTHER pour identifier les termes surrepr&#xe9;sent&#xe9;s de l&#x2019;ontologie g&#xe9;nique et les voies r&#xe9;actomes. Les profils d&#x2019;expression g&#xe8;ne-tissu ont &#xe9;t&#xe9; &#xe9;valu&#xe9;s &#xe0; l&#x2019;aide de GTExv8. R&#xe9;SULTATS: Parmi les 178 g&#xe8;nes &#xe0; preuve solide, les analyses d&#x2019;enrichissement ont r&#xe9;v&#xe9;l&#xe9; une surrepr&#xe9;sentation significative de termes li&#xe9;s &#xe0; la fonction ciliaire et flagellaire (par exemple, mouvement cili&#xe9;, complexe dyn&#xe9;inique), &#xe0; la signalisation endocrinienne (par exemple, liaison des r&#xe9;cepteurs hormonaux, biosynth&#xe8;se des st&#xe9;ro&#xef;des) et aux m&#xe9;canismes de r&#xe9;paration de l&#x2019;ADN, en particulier le complexe nucl&#xe9;aire de l&#x2019;an&#xe9;mie de Fanconi. L&#x2019;analyse des voies r&#xe9;actomes a identifi&#xe9; une surrepr&#xe9;sentation de la biosynth&#xe8;se androg&#xe8;ne, glucocortico&#xef;de et min&#xe9;ralocortico&#xef;de, du transport ciliaire m&#xe9;di&#xe9; par le syndrome de Bardet-Biedl, et de la m&#xe9;iose. Le regroupement d&#x2019;expression tissulaire a identifi&#xe9; des sch&#xe9;mas d&#x2019;expression extra-gonadiques, comportant une implication surr&#xe9;nalienne, hypothalamique et syst&#xe9;mique dans les formes g&#xe9;n&#xe9;tiques d&#x2019;infertilit&#xe9; masculine. CONCLUSIONS: Nos analyses d&#x2019;enrichissement des ensembles g&#xe9;n&#xe9;tiques et d&#x2019;expression tissulaire sugg&#xe8;rent que les causes monog&#xe9;niques de l&#x2019;infertilit&#xe9; masculine sont enrichies dans les voies de la motilit&#xe9; ciliaire, de la r&#xe9;gulation endocrinienne et de la r&#xe9;paration de l&#x2019;ADN, qui jouent &#xe9;galement un r&#xf4;le dans les syst&#xe8;mes d&#x2019;organes extra-gonadiques. Ces r&#xe9;sultats sont coh&#xe9;rents avec des observations &#xe9;pid&#xe9;miologiques liant l&#x2019;infertilit&#xe9; masculine &#xe0; des conditions de sant&#xe9; plus larges et soutiennent une &#xe9;valuation et des soins multidisciplinaires pour les personnes concern&#xe9;es. MOTS-CL&#xe9;S: Infertilit&#xe9; masculine, G&#xe9;n&#xe9;tique, Analyse d&#x2019;Enrichissement des Ensembles g&#xe9;niques, Ontologie g&#xe9;nique, Sant&#xe9; g&#xe9;n&#xe9;rale.

Heat exposure affects spermatogenesis and causes testicular injury through oxidative stress mechanisms. This study examined the preventive benefits of sesame seed oil (SSO) and &#x3b1;-lipoic acid (ALA), both powerful antioxidants, against heat-induced testicular damage. Thirty male Wistar rats were allocated into five groups (n&#x2009;=&#x2009;6 each): control (saline, no heat), heat stress (HS; 43&#xa0;&#xb0;C for 20&#xa0;min/day for 60 days, saline), HS&#x2009;+&#x2009;ALA (100&#xa0;mg/kg), HS&#x2009;+&#x2009;SSO (5 mL/kg), and HS&#x2009;+&#x2009;ALA&#x2009;+&#x2009;SSO. After 60 days, we examined the histology of the testicles, sperm parameters (concentration, motility, viability, morphology, and DNA integrity), oxidative stress markers, apoptotic gene expression, and fertility. These treatments enhanced sperm motility, viability, membrane integrity, and DNA stability while diminishing abnormalities. The levels of antioxidant enzymes (GPx, CAT, TAC, and SOD) and Bcl-2 increased, whereas the levels of pro-apoptotic markers (Bax and caspase-3/9), GSH depletion, MDA, and NO elevation decreased compared to those in the HS group (all p&#x2009;<&#x2009;0.05). The SSO-ALA combination had synergistic effects, improving fertility parameters and alleviating histopathological damage. However, results may be confounded by experimental limitations such as anesthesia effects and lack of dose standardization. These results indicate that SSO and ALA may be effective treatments for heat stress-induced male infertility in animal models, though clinical translation requires further study. L&#x2019;exposition &#xe0; la chaleur affecte la spermatogen&#xe8;se et provoque des l&#xe9;sions testiculaires par des m&#xe9;canismes de stress oxydatif. La pr&#xe9;sente &#xe9;tude a examin&#xe9; les b&#xe9;n&#xe9;fices pr&#xe9;ventifs de l&#x2019;huile de s&#xe9;same (SSO) et de l&#x2019;acide &#x3b1;-lipo&#xef;que (ALA), deux puissants antioxydants, contre les dommages testiculaires induits par la chaleur. Trente rats Wistar m&#xe2;les ont &#xe9;t&#xe9; r&#xe9;partis en 5 groupes (n=6 chacun) : t&#xe9;moins (s&#xe9;rum physiologique, sans chaleur), stress thermique (HS ; 43&#xb0;C pendant 20 min/jour pendant 60 jours, s&#xe9;rum physiologique), HS + ALA (100 mg/kg), HS + SSO (5 mL/kg), et HS + ALA + SSO. Au bout de 60 jours, nous avons &#xe9;valu&#xe9; l&#x2019;histologie des testicules, les param&#xe8;tres spermatiques (concentration, mobilit&#xe9;, viabilit&#xe9;, morphologie et int&#xe9;grit&#xe9; de l&#x2019;ADN), les marqueurs de stress oxydatif, l&#x2019;expression apoptotique des g&#xe8;nes, ainsi que la fertilit&#xe9;. Ces traitements ont am&#xe9;lior&#xe9; la mobilit&#xe9;, la viabilit&#xe9;, l&#x2019;int&#xe9;grit&#xe9; des membranes et la stabilit&#xe9; de l&#x2019;ADN des spermatozo&#xef;des, tout en diminuant les anomalies des spermatozo&#xef;des. Les niveaux d&#x2019;enzymes antioxydants (GPx, CAT, TAC et SOD) et de Bcl-2 ont augment&#xe9;, tandis que les niveaux de marqueurs pro-apoptotiques (Bax et caspase-3/9), de d&#xe9;pl&#xe9;tion du GSH, de MDA et d&#x2019;&#xe9;l&#xe9;vation du NO ont diminu&#xe9; par rapport &#xe0; ceux du groupe HS (tous p < 0,05). La combinaison SSO+ALA a eu des effets synergiques, am&#xe9;liorant les param&#xe8;tres de fertilit&#xe9; et att&#xe9;nuant les dommages histopathologiques. Toutefois, ces r&#xe9;sultats peuvent &#xea;tre biais&#xe9;s par des limitations exp&#xe9;rimentales telles que les effets de l&#x2019;anesth&#xe9;sie et le manque de standardisation des doses utilis&#xe9;es. Ces r&#xe9;sultats indiquent que l&#x2019;huile de s&#xe9;same et l&#x2019;acide &#x3b1;-lipo&#xef;que pourraient &#xea;tre des traitements efficaces en cas d&#x2019;infertilit&#xe9; masculine induite par le stress thermique dans des mod&#xe8;les animaux&#xa0;; cependant, la traduction clinique n&#xe9;cessite des &#xe9;tudes compl&#xe9;mentaires.

Sexually transmitted infections (STIs) contribute to female infertility by causing pelvic inflammatory disease (PID) and fallopian tube damage. Utilizing the Global Burden of Disease (GBD) database, we aim to comprehensively evaluate the global disease burden and spatiotemporal trends of STIs-related infertility, which is critical for formulating targeted intervention strategies. Using data from the GBD 2021 database, we extracted age-standardized prevalence rates (ASPR) and age-specific prevalences (in 5-year intervals from 15 to 49 years) for STIs-related primary infertility (SRPI) and secondary infertility (SRSI) across global, socio-demographic index (SDI) regions, and GBD regions from 1990 to 2021. The analysis of spatiotemporal trends involved calculating estimated annual percentage changes (EAPC) and developing age-period-cohort (A-P-C) models. From 1990 to 2021, global ASPR of SRPI and SRSI remained stable, with EAPCs of -0.18 (95% CI: -0.28 to -0.08) and 0.01 (95% CI: -0.04 to 0.07), respectively. Low SDI regions showed significant burden reduction, while high SDI regions exhibited rising trends. Pathogen-specific trends varied markedly: gonorrhoea-related infertility declined globally (SRPI EAPC = -0.95; SRSI EAPC = -0.61), whereas chlamydia-related SRSI increased slightly (EAPC&#x2009;=&#x2009;0.10). Age-stratified analysis revealed rising SRPI burden in the 40-49 age group and increasing SRSI in the 15-34 age group. SDI and disease burden showed dynamic correlations: negative at low SDI (<&#x2009;0.4) but positive at high SDI (>&#x2009;0.7). The APC model further indicated age effects peak for SRPI and SRSI at 40-44 and 40-45 years, respectively, with declining period effects in high-SDI regions. The global burden of STIs-related infertility exhibits regional and age-specific heterogeneity. While low-SDI regions achieved notable progress, rising burdens in high-SDI areas demand urgent attention. Future strategies should integrate pathogen-specific interventions, age-targeted management, and SDI-driven resource allocation to enhance early screening, treatment, and global reproductive health equity. Not applicable.

Varicocele is a major male infertility issue, and Malva sylvestris shows promise as a treatment due to its antioxidant properties. The present study evaluated the protective effects of Malva sylvestris on testicular health, sperm quality, and oxidative stress-related gene expression. Adult male Wistar rats were randomly assigned into five groups (n&#x2009;=&#x2009;8): the control group, the varicocele model group, the varicocele group with partial occlusion of the left renal vein treated with 750 or 1500 mg/kg Malva sylvestris for 21 days, and a surgical sham group. The epididymal content and Histological analyses of animals testicular tissue were examined to evaluate fertility parameters, and qRT-PCR was employed to determine the expression of SIRT1, FOXO1, NRF2, NF-&#x3ba;B, and TGF-&#x3b2; genes. Varicocele leads to the induction of apoptosis, the occurrence of DNA damage, a reduction in SIRT1 and FOXO1, and an increase in NRF2, TGF-&#x3b2;, and NF-&#x3ba;B gene expression. According to Histological morphometric analysis, treatment with Malva sylvestris showed the increased thickness of Mean Seminiferous Tubule Diameter and Epithelial Thickness in the spermatogenic epithelium, as well as the presence of a greater number of germ cells and mature sperm. In this study, Malva sylvestris treatment showed antioxidative effects since it upregulated the expression of SIRT1 and FOXO1 genes and downregulated the expression of NF-&#x3ba;B, NRF2, and TGF-&#x3b2; genes. Based on the findings, Malva sylvestris as cytoprotective agent modulate key antioxidant pathways, including upregulation of SIRT1 and FOXO1 (linked to cellular repair and OS resistance) and downregulation of pro-inflammatory mediators; then, Malva sylvestris as a promising natural antioxidant for managing varicocele-related infertility, offering a potential adjunct or alternative to conventional therapies. R&#xe9;SUM&#xe9;: CONTEXTE: La varicoc&#xe8;le est un probl&#xe8;me majeur d&#x2019;infertilit&#xe9; masculine, et Malva sylvestris est prometteuse en tant que traitement, en raison de ses propri&#xe9;t&#xe9;s antioxydantes. La pr&#xe9;sente &#xe9;tude a &#xe9;valu&#xe9; les effets protecteurs de Malva sylvestris sur la sant&#xe9; testiculaire, la qualit&#xe9; du sperme et l&#x2019;expression des g&#xe8;nes li&#xe9;s au stress oxydatif. Des rats Wistar m&#xe2;les adultes ont &#xe9;t&#xe9; r&#xe9;partis au hasard en cinq groupes (n = 8) : groupe t&#xe9;moin, groupe mod&#xe8;le varicoc&#xe8;le, groupe varicoc&#xe8;le avec occlusion partielle de la veine r&#xe9;nale gauche trait&#xe9; avec 750 ou 1500 mg/kg de Malva sylvestris pendant 21 jours, et groupe simul&#xe9; chirurgicalement. Le contenu &#xe9;pididymaire et les analyses histologiques de tissu testiculaire des animaux ont &#xe9;t&#xe9; examin&#xe9;s pour &#xe9;valuer les param&#xe8;tres de fertilit&#xe9;, et la qRT-PCR a &#xe9;t&#xe9; utilis&#xe9;e pour d&#xe9;terminer l&#x2019;expression des g&#xe8;nes SIRT1, FOXO1, NRF2, NF-&#x3ba;B et TGF-&#x3b2;. R&#xe9;SULTATS: La varicoc&#xe8;le entra&#xee;ne l&#x2019;induction d&#x2019;une apoptose, l&#x2019;apparition de dommages &#xe0; l&#x2019;ADN, une r&#xe9;duction de SIRT1 et FOXO1, et une augmentation de l&#x2019;expression des g&#xe8;nes NRF2, TGF-&#x3b2; et NF-&#x3ba;B. Selon l&#x2019;analyse morphom&#xe9;trique histologique, le traitement par Malva sylvestris a montr&#xe9; une augmentation de la moyenne de l&#x2019;&#xe9;paisseur du tube s&#xe9;minif&#xe8;re et de l&#x2019;&#xe9;paisseur &#xe9;pith&#xe9;liale de l&#x2019;&#xe9;pith&#xe9;lium s&#xe9;minif&#xe8;re, ainsi que la pr&#xe9;sence d&#x2019;un plus grand nombre de cellules germinales et de spermatozo&#xef;des matures. Le traitement par Malva sylvestris a montr&#xe9; des effets antioxydants puisqu&#x2019;il r&#xe9;gulait &#xe0; la hausse l&#x2019;expression des g&#xe8;nes SIRT1 et FOXO1 et &#xe0; la baisse l&#x2019;expression des g&#xe8;nes NF-&#x3ba;B, NRF2 et TGF-&#x3b2;. CONCLUSIONS: Sur la base des r&#xe9;sultats, Malva sylvestris, en tant qu&#x2019;agent cytoprotecteur, module les principales voies antioxydantes, y compris la r&#xe9;gulation &#xe0; la hausse de SIRT1 et FOXO1, et la r&#xe9;gulation &#xe0; la baisse des m&#xe9;diateurs pro-inflammatoires. Malva sylvestris, en tant qu&#x2019;antioxydant naturel prometteur pour la gestion de l&#x2019;infertilit&#xe9; li&#xe9;e &#xe0; la varicoc&#xe8;le, offre un compl&#xe9;ment potentiel ou une alternative aux th&#xe9;rapies conventionnelles.

BACKGROUND: It is challenging to distinguish between testicular torsion (TT) and epididymorchitis (EO) due to their overlapping symptoms. This study evaluated the diagnostic value of the glucose/potassium ratio (GPR) and a combined model for distinguishing between TT, EO, and non-specific acute scrotal pain. This retrospective study included 373 patients, who were divided into three groups: TT (n&#x2009;=&#x2009;103), EO (n&#x2009;=&#x2009;120), and non-specific pain controls (n&#x2009;=&#x2009;150). GPR and systemic inflammatory indices were calculated from admission blood samples. A combined model incorporating independent predictors (age, GPR, and white blood cell (WBC) count) was constructed using binary logistic regression. Diagnostic performance was assessed using a receiver operating characteristic (ROC) curve and multivariate logistic regression analysis. RESULTS: The median GPR was highest in the TT group (23.6), followed by the EO group (21.0) and the control group (20.4) (p&#x2009;<&#x2009;0.001). A GPR cut-off value of >&#x2009;21.8 was associated with a 3.52-fold increased risk of testicular torsion (OR: 3.52, 95% CI: 1.97&#x2013;6.25; p&#x2009;<&#x2009;0.001). Although the GPR demonstrated the greatest accuracy among the individual markers (AUC: 0.738), the combined model produced superior diagnostic results, with an AUC of 0.839 (sensitivity: 75.6%; specificity: 81.5%; positive predictive value (PPV): 60.9%; negative predictive value (NPV): 89.7%). Multivariate analysis identified the following as independent predictors of testicular torsion: younger age (OR: 0.92); higher WBC count (OR: 1.30); and higher GPR levels (OR: 1.14). CONCLUSIONS: GPR appears to be a biomarker that could reflect specific metabolic stress in testicular ischaemia, which is distinct from the inflammatory response in EO. The combined model demonstrated the highest diagnostic accuracy in our cohort, suggesting its potential usefulness as an adjunctive triage tool. However, these findings are preliminary and require external validation in future prospective, multicentre studies before routine clinical implementation. Il est difficile de distinguer une torsion testiculaire (TT) d&#x2019;une &#xe9;pididymo-orchite (EO) en raison du chevauchement de leurs sympt&#xf4;mes. La pr&#xe9;sente &#xe9;tude a &#xe9;valu&#xe9; la valeur diagnostique du rapport glucose/potassium (RGP) ainsi qu&#x2019;un mod&#xe8;le combin&#xe9; pour distinguer entre TT, EO et douleur scrotale aigu&#xeb; non sp&#xe9;cifique. Cette &#xe9;tude r&#xe9;trospective a inclus 373 patients, r&#xe9;partis en trois groupes : TT (n = 103), EO (n = 120) et t&#xe9;moins d&#x2019;une douleur non sp&#xe9;cifique (n = 150). Le RGP et les indices inflammatoires syst&#xe9;miques ont &#xe9;t&#xe9; calcul&#xe9;s &#xe0; partir d&#x2019;&#xe9;chantillons sanguins lors de l&#x2019;admission. Un mod&#xe8;le combin&#xe9; incorporant des pr&#xe9;dicteurs ind&#xe9;pendants (&#xe2;ge, RGP et nombre de globules blancs (GB)) a &#xe9;t&#xe9; construit &#xe0; l&#x2019;aide d&#x2019;une r&#xe9;gression logistique binaire. La performance diagnostique a &#xe9;t&#xe9; &#xe9;valu&#xe9;e &#xe0; l&#x2019;aide d&#x2019;une courbe de caract&#xe9;ristiques de fonctionnement du r&#xe9;cepteur (ROC) et d&#x2019;une analyse de r&#xe9;gression logistique multivari&#xe9;e. La valeur m&#xe9;diane du RGP &#xe9;tait la plus &#xe9;lev&#xe9;e dans le groupe TT (23,6) suivi par le groupe EO (21) et le groupe t&#xe9;moin (20,4) (p < 0,001). Une valeur seuil du RGP sup&#xe9;rieure &#xe0; 21,8 &#xe9;tait associ&#xe9;e &#xe0; un risque accru de torsion testiculaire de 3,5 fois plus grand (OR : 3,52 ; IC &#xe0; 95 % : 1,97&#x2013;6,25 ; p < 0,001). Bien que le RGP ait d&#xe9;montr&#xe9; la plus grande pr&#xe9;cision parmi les marqueurs individuels (AUC : 0,738), le mod&#xe8;le combin&#xe9; a produit des r&#xe9;sultats diagnostiques sup&#xe9;rieurs, avec une AUC de 0,839 (sensibilit&#xe9; : 75,6 % ; sp&#xe9;cificit&#xe9; : 81,5 % ; valeur pr&#xe9;dictive positive : 60,9 % ; valeur pr&#xe9;dictive n&#xe9;gative : 89,7 %). L&#x2019;analyse multivari&#xe9;e a identifi&#xe9; les pr&#xe9;dicteurs ind&#xe9;pendants de la torsion testiculaire : un &#xe2;ge plus jeune (OR : 0,92) ; un nombre plus &#xe9;lev&#xe9; de GB (OR : 1,30) ; et des niveaux de RGP plus &#xe9;lev&#xe9;s (OR : 1,14). Le RGP semble &#xea;tre un biomarqueur pouvant refl&#xe9;ter un stress m&#xe9;tabolique sp&#xe9;cifique de l&#x2019;isch&#xe9;mie testiculaire, ce qui est distinct de la r&#xe9;ponse inflammatoire dans l&#x2019;EO. Le mod&#xe8;le combin&#xe9; a d&#xe9;montr&#xe9; la plus grande pr&#xe9;cision diagnostique dans notre cohorte, ce qui sugg&#xe8;re son utilit&#xe9; potentielle comme outil de tri compl&#xe9;mentaire. Cependant, ces r&#xe9;sultats sont pr&#xe9;liminaires et n&#xe9;cessitent une validation externe dans de futures &#xe9;tudes prospectives multicentriques avant une mise en &#x153;uvre clinique de routine.

The formal two-layer microsurgical technique is considered the gold standard for vasovasostomy (VV) because of its excellent outcomes; however, it is technically demanding and time-consuming. In this study, we compared the outcomes of modified one-layer and formal two-layer microsurgical VV in men undergoing VV. This retrospective analysis included 62 men who underwent bilateral microsurgical VV performed by a single surgeon between 2017 and 2024. The formal two-layer and modified one-layer techniques were performed in 27 and 35 men, respectively. The mean operative time was significantly shorter with the modified one-layer technique than with the formal two-layer technique (118.89&#x2009;&#xb1;&#x2009;7.99 vs. 152.52&#x2009;&#xb1;&#x2009;9.31&#xa0;min, P&#x2009;<&#x2009;0.001). Patency rates (91.43% [32/35] vs. 92.59% [25/27], P&#x2009;=&#x2009;0.448) and pregnancy rates (34.29% [12/35] vs. 37.04% [10/27], P&#x2009;=&#x2009;0.822) were comparable between the two groups. Postoperative sperm concentration and motility did not differ between the two groups. No complications and postoperative reobstruction were observed in either group. Compared with formal two-layer microsurgical VV, the modified one-layer technique achieved comparable patency and pregnancy rates while reducing technical difficulty and operative time. It may therefore represent an alternative surgical approach with potential clinical benefits for VV. R&#xe9;SUM&#xe9;: CONTEXTE: La technique microchirurgicale officielle &#xe0; deux couches est consid&#xe9;r&#xe9;e comme la r&#xe9;f&#xe9;rence absolue pour la vaso-vasostomie (VV) en raison de ses excellents r&#xe9;sultats ; cependant, elle est techniquement exigeante et chronophage. Dans cette &#xe9;tude, nous avons compar&#xe9; les r&#xe9;sultats de la VV microchirurgicale modifi&#xe9;e &#xe0; une couche et celle officielle &#xe0; deux couches, chez des hommes en demande de VV. R&#xe9;SULTATS: Cette analyse r&#xe9;trospective a inclus 62 hommes b&#xe9;n&#xe9;ficiant d&#x2019;une VV microchirurgicale bilat&#xe9;rale r&#xe9;alis&#xe9;e par un seul chirurgien entre 2017 et 2024. Les techniques officielle &#xe0; deux couches et &#xe0; une couche modifi&#xe9;e ont &#xe9;t&#xe9; r&#xe9;alis&#xe9;es respectivement avec 27 et 35 hommes. Le temps op&#xe9;ratoire moyen &#xe9;tait nettement plus court avec la technique modifi&#xe9;e &#xe0; une couche qu&#x2019;avec la technique officielle &#xe0; deux couches (118,89 &#xb1; 7,99 versus 152,52 &#xb1; 9,31 min, p < 0,001). Les taux de perm&#xe9;abilisation (91,4 % [32/35] versus 92,6 % [25/27] p = 0,448) et les taux de grossesse (34,3 % [35/12] versus 37,0 % [27/10] p = 0,822) &#xe9;taient comparables entre les deux groupes. La concentration et la mobilit&#xe9; postop&#xe9;ratoires des spermatozo&#xef;des ne diff&#xe9;raient pas entre les deux groupes. Aucune complication ni r&#xe9;-obstruction postop&#xe9;ratoires n&#x2019;ont &#xe9;t&#xe9; observ&#xe9;es dans aucun des deux groupes. CONCLUSION: Compar&#xe9;e &#xe0; la VV microchirurgicale officielle &#xe0; deux couches, la technique modifi&#xe9;e &#xe0; une couche a permis d&#x2019;atteindre des taux de perm&#xe9;abilit&#xe9; et de grossesse comparables, tout en r&#xe9;duisant la difficult&#xe9; technique et le temps op&#xe9;ratoire. Par cons&#xe9;quent, cela pourrait repr&#xe9;senter une approche chirurgicale alternative avec des b&#xe9;n&#xe9;fices cliniques potentiels pour la VV.

BACKGROUND: Non-obstructive azoospermia is the most severe and common form, representing 10&#x2013;15% of infertile men. For these patients, testicular sperm extraction followed by intracytoplasmic sperm injection offer the only viable fertility option. However, sperm retrieval rates in non-obstructive azoospermia remain significantly lower than in obstructive azoospermia. Optimizing testicular sperm extraction outcomes in non-obstructive azoospermia requires understanding the clinical, hormonal, genetic, and histological factors that influence sperm retrieval. The present study aims to evaluate the impact of key clinical and biological factors on sperm retrieval out comes in patients with non-obstructive azoospermia from eastern Algeria, with the goal of improving retrieval rates and identifying reliable predictive factors for successful sperm recovery. RESULT: Sperm retrieval was successful in 38.3% of patients with non-obstructive azoospermia. Testicular histology had a significant impact on retrieval outcomes (p&#x2009;<&#x2009;0.001). The highest sperm retrieval rates were observed in patients with late maturation arrest and hypospermatogenesis. In contrast, severe histological patterns, particularly testicular fibrosis and Sertolicell-only syndrome, were strongly associated with sperm retrieval failure, with odds ratios of 0.024 and 0.020, respectively. Serum follicle-stimulating hormone and luteinizing hormone levels were significantly correlated with sperm retrieval success (p&#x2009;=&#x2009;0.004 and p&#x2009;=&#x2009;0.05, respectively). Logistic regression analysis showed an odds ratio of 0.947 for FSH, with a cut-off value of 8.83 mIU/mL, indicating that lower FSH levels were associated with higher retrieval success. For LH, the odds ratio was 1.069, with a cut-off value of 5.75 mIU/mL. CONCLUSION: Overall, testicular histology, serum follicle-stimulating hormone levels, and testicular volume emerged as the most important independent predictors of sperm retrieval success in Algerian patients with non-obstructive azoospermia undergoing testicular sperm extraction. Luteinizing hormone was identified as a weaker predictive factor compared with FSH and testicular volume. Although, histological evaluation is obtained post-biopsy, it remains clinically valuable by guiding personalized patient management, including the selection of the most appropriate sperm retrieval technique, the initiation of hormonal therapy, and the prediction of outcomes in subsequent retrieval attempts. R&#xe9;SUM&#xe9;: CONTEXTE: L&#x2019;azoospermie non obstructive (ANO) est la forme la plus s&#xe9;v&#xe8;re et la plus courante, pr&#xe9;sente chez 10 &#xe0; 15 % des hommes infertiles. Pour ces patients, l&#x2019;extraction testiculaire de spermatozo&#xef;des suivie d&#x2019;une injection intracytoplasmique de spermatozo&#xef;des repr&#xe9;sente la seule option viable de fertilit&#xe9;. Cependant, les taux de pr&#xe9;l&#xe8;vement de spermatozo&#xef;des dans l&#x2019;ANO restent significativement plus faibles que dans l&#x2019;azoospermie obstructive. Optimiser les r&#xe9;sultats d&#x2019;extraction des spermatozo&#xef;des testiculaires lors d&#x2019;une ANO n&#xe9;cessite de comprendre les facteurs cliniques, hormonaux, g&#xe9;n&#xe9;tiques et histologiques qui influencent la r&#xe9;cup&#xe9;ration des spermatozo&#xef;des. La pr&#xe9;sente &#xe9;tude vise &#xe0; &#xe9;valuer l&#x2019;impact des principaux facteurs cliniques et biologiques sur les r&#xe9;sultats de pr&#xe9;l&#xe8;vement de spermatozo&#xef;des chez les patients atteints d&#x2019;ANO provenant de l&#x2019;est de l&#x2019;Alg&#xe9;rie, dans le but d&#x2019;am&#xe9;liorer les taux de pr&#xe9;l&#xe8;vement et d&#x2019;identifier des facteurs pr&#xe9;dictifs fiables pour une r&#xe9;cup&#xe9;ration r&#xe9;ussie des spermatozo&#xef;des. R&#xe9;SULTATS: La r&#xe9;cup&#xe9;ration de spermatozo&#xef;des a &#xe9;t&#xe9; r&#xe9;ussie chez 38,3 % des patients atteints d&#x2019;ANO. L&#x2019;histologie testiculaire a eu un impact significatif sur les r&#xe9;sultats de la ponction (p < 0,001). Les taux de pr&#xe9;l&#xe8;vement de spermatozo&#xef;des les plus &#xe9;lev&#xe9;s ont &#xe9;t&#xe9; observ&#xe9;s chez les patients pr&#xe9;sentant un arr&#xea;t tardif de maturation et une hypospermatogen&#xe8;se. En revanche, les profiles histologiques s&#xe9;v&#xe8;res, en particulier la fibrose testiculaire et le syndrome des cellules de Sertoli seules, &#xe9;taient fortement associ&#xe9;s &#xe0; l&#x2019;&#xe9;chec du pr&#xe9;l&#xe8;vement de spermatozo&#xef;des, avec des odds ratios respectivement de 0,024 et 0,020. Les taux s&#xe9;riques de FSH et de LH &#xe9;taient significativement corr&#xe9;l&#xe9;s au succ&#xe8;s du pr&#xe9;l&#xe8;vement des spermatozo&#xef;des (respectivement p = 0,004 et p = 0,05). L&#x2019;analyse de r&#xe9;gression logistique a montr&#xe9; un odds ratio de 0,947 pour la FSH, avec une valeur seuil de 8,83 mIU/mL, indiquant que des niveaux plus faibles de FSH &#xe9;taient associ&#xe9;s &#xe0; un succ&#xe8;s de la ponction plus &#xe9;lev&#xe9;. Pour la LH, l&#x2019;odds ratio &#xe9;tait de 1,069, avec une valeur seuil de 5,75 mIU/mL. CONCLUSION: Dans l&#x2019;ensemble, l&#x2019;histologie testiculaire, les niveaux de FSH s&#xe9;riques et le volume testiculaire sont apparus comme les principaux pr&#xe9;dicteurs ind&#xe9;pendants du succ&#xe8;s de la r&#xe9;cup&#xe9;ration de spermatozo&#xef;des chez les patients atteints d&#x2019;ANO lors d&#x2019;une extraction de spermatozo&#xef;des testiculaires. La LH a &#xe9;t&#xe9; identifi&#xe9;e comme un facteur pr&#xe9;dictif plus faible que la FSH et le volume testiculaire. Bien que l&#x2019;&#xe9;valuation histologique soit r&#xe9;alis&#xe9;e apr&#xe8;s la biopsie, elle reste cliniquement pr&#xe9;cieuse en guidant une prise en main personnalis&#xe9;e du patient, incluant le choix de la technique de pr&#xe9;l&#xe8;vement la plus appropri&#xe9;e, et la pr&#xe9;diction des r&#xe9;sultats lors des tentatives ult&#xe9;rieures. MOTS-CL&#xe9;S: Histologie testiculaire, Pr&#xe9;dicteurs du Pr&#xe9;l&#xe8;vement de Spermatozo&#xef;des, Azoospermie non obstructive, Biopsie testiculaire.