Microplastics (MPs), plastic particles smaller than 5 mm, are ubiquitous environmental contaminants and have been reported in human blood, placenta, semen, testis, ovarian follicular fluid, and penile tissue. This narrative review examines evidence relevant to reproductive and sexual health, with emphasis on endocrine signaling, oxidative stress, inflammation, and possible multigenerational effects. Human studies currently demonstrate tissue detection and, in cross-sectional semen studies, associations with selected semen parameters; they do not establish causation. In rodents, fish, invertebrates, and in vitro systems, MP exposure has been associated with impaired spermatogenesis and steroidogenesis, ovarian granulosa-cell injury, altered oocyte maturation, placental dysfunction, and reduced erectile function. Evidence concerning pregnancy outcomes and assisted reproductive technology (ART) remains predominantly experimental or hypothetical. The available literature therefore supports biological plausibility and the need for standardized exposure assessment and longitudinal human studies, but not firm clinical risk estimates or causal conclusions.

Subcutaneous silicone penile sleeve implants, including Penuma and Himplant, are used to increase flaccid penile dimensions and for selected reconstructive indications, but the magnitude of dimensional change and complication profile have not been systematically quantified. This systematic review and single-arm meta-analysis evaluated clinical outcomes after Penuma/Himplant implantation. Cohort studies with clearly defined denominators and extractable outcome data were included in the quantitative synthesis, whereas reports addressing special indications or complications were summarized narratively. Twelve publications from 2018 to 2026 met the inclusion criteria, of which four cohort studies were suitable for primary meta-analysis. The pooled mean increase was 3.77 cm in flaccid girth and 2.94 cm in flaccid length. Pooled complication rates were 3.03% for infection, 5.03% for seroma, 5.12% for erosion or implant exposure, 3.53% for revision, and 7.08% for explantation or implant removal. These descriptive findings are limited to flaccid penile dimensions and do not establish comparative effectiveness; data on erect dimensions and patient-reported outcomes were limited, with validated instruments rarely used. Prospective comparative studies using standardized penile measurements, formal psychological assessment, validated outcome instruments, and longer follow-up are required.

Device infection after inflatable penile prosthesis implantation typically mandates explantation and follows 1-3% of primary implants, a central concern as prosthetic surgery migrates to ambulatory surgery centers. We retrospectively studied all primary implantations by one surgeon while the practice operated an ambulatory program (October 2021-February 2024; the ambulatory program ended for non-clinical administrative reasons). Device, systemic prophylaxis, no-touch technique, and incision were identical between the ambulatory center and a contemporaneous hospital outpatient comparison; intraoperative irrigation was concordant between the ambulatory center and its principal hospital comparator but not across all hospital facilities. Device infection was defined as reoperation for infection within 90 days; reoperation at any interval was also screened. Of 547 primary implantations (ambulatory 218; hospital 329), no infections occurred in the ambulatory arm (0.00%, 95% confidence interval 0.00-1.68%); the hospital rate was 0.61% and the overall rate 0.37% (p = 0.52). Assignment to setting was not random, and the covariates ordinarily governing it - American Society of Anesthesiologists class, body mass index, anticoagulation, cardiopulmonary risk - were unavailable, so baseline risk cannot be assumed equal. With two events these data cannot establish non-inferiority or superiority; they characterize outcomes under one standardized protocol in two settings. These preliminary findings suggest that primary inflatable penile prosthesis implantation may be performed in an ambulatory setting without an apparent increase in infection risk when a standardized infection-prevention protocol is adopted; however, larger prospective studies are required.

Surgical implantation of an inflatable penile prosthesis is considered the gold-standard treatment for severe erectile dysfunction. Reservoir placement is one of the most challenging steps of this procedure and requires knowledge of the related anatomy. To meet these demands, we have established a postgraduate masterclass program on penile prosthesis implantation that identifies the essential anatomical landmarks demonstrated in predissected anatomical specimens and offers a step-by-step surgical training carried out in body donors under tutored guidance. The main focus of this study is the technical application of our didactic and educational approach by providing high-quality descriptive anatomical illustrations. Surgical steps and anatomical structures relevant for reservoir placement in both the retropubic ("traditional") and submuscular abdominal ("ectopic") spaces are described and visualized. Anatomical dissections were performed by clinical anatomists in close collaboration with high-volume implanters and reconstructive surgeons. This unique cooperation between theoretical and practical disciplines allowed a detailed focus on shared anatomical targets, providing a comprehensive understanding of the key landmarks in the context of reservoir placement. These technical guidelines and anatomical considerations are indispensable prerequisites for minimizing the risk of complications associated with reservoir placement.

Penile prosthesis (PP) implantation remains the most definitive treatment for medication-refractory erectile dysfunction (ED). Despite reductions in infection rates achieved through improved PP coatings, antimicrobial protocols, and refined surgical techniques, PP infection continues to impose clinical and economic burdens. To overcome these intrinsic constraints, we introduce the Zero-Touch Technique (ZTT), a fundamentally new operative paradigm enabled by a purpose-designed sterile genital barrier system. This system consists of an anatomically contoured non-adhesive penile sheath, an adhesive scrotal and suprapubic isolation layer, and lateral anchoring wings that create a 360-degree sealed sterile field. Applied immediately after antiseptic preparation and before incision, the barrier completely isolates the penis and scrotum, allowing all subsequent steps-including exposure, dilation, implantation, pump placement, and device cycling-to occur without contact with hair-bearing genital skin. ZTT has the potential to improve infection prevention in PP surgery and may contribute to establishing a new sterility standard pending further validation.

Although masturbation is common, the association between masturbation-related behaviors and self-estimated intravaginal ejaculation latency time (sIELT) has not been studied. This single-centre retrospective study examined associations between sIELT and masturbatory parameters in 470 male clinic attendees (January 2020-March 2022). sIELT was dichotomised as ≤3 vs >3 min (n = 322 vs 148). Masturbatory grip strength and perceived intravaginal pressure were quantified with a blood-pressure cuff (mmHg; three trials averaged); their differential (G-I) was derived. Hand position was pre-specified as P1-P2 (glans-dominant), P3-P5 (shaft-dominant), or P1-P5 (full-length). The primary analysis used multivariable logistic regression adjusting for age and body mass index (BMI); exploratory sensitivity analyses are reported in the Supplementary Appendix. Compared with the ≤3-min group, the >3-min group had higher G-I (median 5.5 vs 0 mmHg; p < 0.001). Group differences were not significant for grip strength (p = 0.06), perceived intravaginal pressure (p = 0.06), monthly frequency (p = 0.58), duration (p = 0.31), or age at onset (p = 0.05). Shaft-dominant masturbation was more frequent in the >3-min group (55.4 vs 31.4%; p < 0.001) and full-length less frequent (32.4 vs 49.7%; p < 0.001). In multivariable logistic regression adjusted for age and BMI, each 10-mmHg increase in G-I was associated with higher odds of sIELT >3 min (adjusted OR 1.27, 95% CI 1.11-1.44; p < 0.001), and shaft-dominant masturbation was associated with higher odds of sIELT >3 min than full-length masturbation (adjusted OR 2.76, 95% CI 1.77-4.30; p < 0.001). Sensitivity analyses supported the robustness of the main findings; conclusions remain regression-based.

Male contraception has been utilized for thousands of years and has included abstinence, withdrawal or coitus interruptus, condom usage, and vasectomy. With a rapidly changing reproductive health landscape, there is continued interest and an acute need for new and innovative forms of male contraception. This manuscript aims to look at the history of male contraception as currently used today and to look at future applications. Peer-reviewed and lay literature was examined to discuss the history and to examine the future directions of the field. Barrier male contraception was first recorded in history in 3000 B.C with the use of animal-based penile sheaths in Crete. Charles Goodyear's invention of rubber vulcanization during the Industrial Revolution enabled the mass production of more durable rubber condoms, which were later refined with the introduction of latex in the 1920s. Vasectomy was first explored for use in the treatment of lower urinary tract symptoms of benign prostatic hyperplasia prior to its modern use as contraception. The history of vasectomy is complex, as it was misused in eugenic programs in the United States and other countries during the 19th and 20th centuries. These involuntary sterilization programs, aimed at preventing individuals deemed "undesirable" from procreating, were eventually outlawed. Voluntary vasectomy has been a mainstay of permanent male contraception in modern history for decades. Ongoing research continues into novel therapies for male contraception, including both hormonal and non-hormonal methods. With continued interest in providing men with safe and effective forms of contraception, continued research into novel therapies is of the utmost importance.