Reproductive postponement in contemporary Czechia is not only a demographic trend but also a clinically relevant challenge. Delaying parenthood increases the probability of prolonged time to pregnancy, reproductive difficulties, need for specialized fertility care and non-realization of reproductive intentions. This narrative review integrates Czech demographic evidence with clinical aspects of female and male reproductive ageing, couple-based infertility evaluation, and the possibilities and limitations of assisted reproduction. Particular attention is paid to the psychosexual impact of prolonged attempts to conceive, including loss of sexual spontaneity, pressure associated with timed intercourse, reduced desire, erectile and ejaculatory difficulties, dyspareunia, shame, silence and treatment fatigue. The article emphasizes early, realistic and non-judgmental fertility education, simultaneous assessment of both partners, and interdisciplinary cooperation among gynaecology, reproductive medicine, urology, andrology, sexual medicine and psychosocial care. The aim is not to impose normative pressure toward earlier parenthood, but to support informed reproductive decision-making and reduce the health and relational consequences of late initiation of reproductive plans.

Topiramate is a widely prescribed antiepileptic drug with a multimodal mechanism of action. However, its effects on male reproductive function remain poorly characterized. This study was conducted to investigate the impact of this drug on testicular and epididymal function in adult male Wistar rats. Animals were treated orally for 21 days with topiramate at 40 or 160 mg/kg. Serum testosterone levels, testicular histomorphology, spermatogenic indices, sperm parameters, and epididymal duct contractility were subsequently evaluated. The treatment did not alter serum testosterone levels at either dose. However, both doses reduced Sertoli cell and round spermatid numbers, increased primary spermatocyte counts, and decreased meiotic and overall spermatogenic yields, whereas only the higher dose (160 mg/kg) reduced Sertoli cell efficiency and daily sperm production. The lower dose (40 mg/kg) increased sperm morphological abnormalities, whereas the higher dose reduced total and progressive sperm motility and induced both head and tail defects. Additionally, treatment with topiramate at 160 mg/kg prolonged sperm transit time in the cauda epididymis and reduced contractile responses of the distal cauda epididymal duct to KCl, noradrenaline, and carbachol, suggesting impaired epididymal transport and potential ejaculatory dysfunction. Altogether, these findings demonstrate that topiramate adversely affects male reproductive function. Given its widespread use in individuals of reproductive age, these results underscore the need for translational studies in humans to assess potential reproductive risks associated with this therapy.

Premature ejaculation (PE) is a prevalent male sexual disorder with an incompletely understood pathogenesis and limited effective therapeutic strategies. Although the gut microbiota has been implicated in several diseases, its association with PE remains unclear. Metabolomic analyses and metagenomic sequencing were performed to compare the intestinal microbiota profiles between 20 patients with PE and 20 healthy controls, investigating the association between PE and gut microbiota. Comprehensive analysis revealed distinct microbial signatures between PE and control groups. The PE group exhibited significantly reduced relative abundances of Bifidobacteriaceae bacterium, Blautia, Coprobacillus, Ruminococcus sp. ctHOG1, Siphoviridae, and Alistipes. Metabolomic profiling identified 150 upregulated and 73 downregulated metabolites between the two groups. Kyoto encyclopedia of genes and genomes pathway enrichment analysis indicated significant enrichment of several potential signaling pathways in the PE group. This study characterized distinct gut microbiota features in patients with PE compared with healthy controls and investigated microbiota-associated pathways potentially related to PE through integrated metabolomics analysis. The findings provide preliminary insights into microbiome-associated alterations in PE.

Background Lower urinary tract symptoms (LUTS), highly prevalent among aging men, adversely affect the quality of life. Pharmacological management has evolved with multiple drug classes, but real-world prescribing patterns in India have not been adequately studied. Thus, we evaluated prescription trends among Indian urologists for the management of male LUTS, assessed symptom patterns, evaluated factors influencing choice of fixed-dose combination (FDC), with special focus on silodosin-mirabegron FDC, and identified adverse events (AEs) and adherence. Methods This cross-sectional, questionnaire-based survey was performed over three months (January 2, 2026, to April 5, 2026) and included 110 Indian urologists actively managing male patients with LUTS. A 27-item structured questionnaire captured demographic characteristics, clinical practice patterns, and prescribing preferences for LUTS pharmacotherapy, including monotherapies, combination therapies, and FDCs, along with AEs and adherence. Results Of 135 urologists invited, 110 (81.48%) completed the survey. LUTS mainly involved a combination of storage, voiding, and post-micturition symptoms (n = 59, 53.6%). As a class, α1-blockers were the most frequently prescribed monotherapy (n = 109, 99.1% frequent/very frequent use), with silodosin (n = 98, 89.1%) and tamsulosin (n = 84, 76.4%) being most preferred. Use of dutasteride (n = 108, 98.2%) exceeded finasteride (n = 13, 11.8%). In patients with benign prostatic hyperplasia (BPH) with overactive bladder, silodosin-mirabegron was the most favored FDC (n = 97, 88.2%). FDCs of α1-blockers with muscarinic receptor antagonists and β-3 adrenergic agonists were preferred due to their proven efficacies (n = 83, 75.5% and n = 87, 79.1%, respectively) and lower incidences of AEs (n = 69, 62.7% and n = 80, 72.7%). Common AEs included dry mouth (n = 73, 66.4%), anejaculation (n = 69, 62.7%), and headache (n = 67, 60.9%). Moderate adherence (25%-75%) was reported by 95 (86.4%) urologists. Conclusion Adherence to pharmacotherapy, as assessed by participating urologists, was moderate, with urologists preferring silodosin as first-line therapy and silodosin-mirabegron FDC for mixed LUTS.