Awake urological procedures, including cystoscopy, transrectal ultrasound-guided prostate biopsy (TRUS-Bx), extracorporeal shock wave lithotripsy, vasectomy, and urodynamic studies, are consistently associated with procedural pain and anxiety, with downstream consequences for surveillance compliance and patient experience. Head-mounted display (HMD) virtual reality (VR) has emerged as a non-pharmacological adjunct, but existing reviews have been narrative or restricted to a single procedure type. This systematic review and meta-analysis evaluated head-mounted display VR across the full breadth of awake urological procedures. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2026. Eligible studies were randomised controlled trials (RCTs) of HMD VR compared with standard care in adults undergoing office-based urological procedures under local anaesthesia. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the revised Cochrane risk of bias tool (RoB 2). Random-effects meta-analyses used the standardised mean difference (SMD) with Hedges' g. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Eleven RCTs encompassing 1,557 participants across eight countries were included. The VR was associated with statistically significant reductions in procedural pain (SMD -0.68, 95% CI -1.25 to -0.11) and anxiety (SMD -1.39, 95% CI -2.64 to -0.14), although both estimates carried substantial heterogeneity (I² = 91.7% and 89%, respectively). Subgroup analysis of pain by procedure type revealed marked divergence: VR produced negligible benefit during cystoscopy (SMD -0.16, 95% CI -0.32 to 0.00) but a large reduction during TRUS-Bx (SMD -1.84, 95% CI -2.82 to -0.85), the latter based on only two studies with substantial heterogeneity. Narrative synthesis showed consistent improvements in patient satisfaction and procedural comfort and attenuation of physiological stress markers. No serious VR-related adverse events were identified across approximately 900 patients. The certainty of evidence was low for all outcomes. The HMD VR may offer meaningful reductions in procedural pain and anxiety during selected awake urological procedures, particularly those characterised by sustained nociceptive stimulation and high anticipatory distress, with a consistent safety profile. However, the very high between-study heterogeneity means these pooled averages should be interpreted cautiously, and the benefit appears procedure-specific rather than uniform. The benefit appears procedure-specific and is unlikely to exceed established pharmacological standards during routine cystoscopy. Adequately powered procedure-specific trials are needed before VR can be considered a standard adjunct.

Gonadectomy (ovariohysterectomy/ovariectomy and orchiectomy) has been the standard of surgical sterilization in dogs and cats. In many countries it has been performed at peri-pubertal or early post-pubertal age in clinical practice and at pre-pubertal age in shelters with merit and in others for breeders that wish to enforce and ensure breeding restrictions before sale. Early age gonadectomy (pre, peri, and early post-pubertal) is increasingly being questioned due to potential health detriments, particularly in large and giant breed dogs. In clinical practice, clients are increasingly becoming aware of alternative options to reproduction control and seek advice from their veterinarian who play a crucial role in guiding these decisions. Hysterectomy in female dogs and vasectomy in male dogs offer a permanent surgical sterilization option without disruption of the hormones and can be performed at traditional age (5-12 months in many countries) or early age (6-10 weeks) via surgical or laparoscopic means. It is very important that the entire uterus, including the uterine body must be removed, as otherwise pyometra remains a possibility. In queens, persistent oestrus occurs and pseudocyesis may occur. This, together with unwanted behaviours in both sexes, excludes gonad sparing procedures as routine option for owned cats. Sterility with preservation of hormones (hysterectomy, vasectomy, epididymectomy) has been suggested for feral cat populations. Hysterectomy and vasectomy in dogs can offer an effective solution for those who wish to reduce risk of early loss of hormones, eliminate the inconveniences of bloody vaginal discharge and the risk of unwanted pregnancy in effort to postpone gonadectomy at a much later age. Long term studies regarding outcome are needed, hence in clinical practice, hysterectomy is mostly advised as method of delaying gonadectomy.

The aim of the present study was to report a case of malignant mesothelioma of the tunica vaginalis testis (MMTVT) and to discuss clinicopathological features and therapeutic dilemmas to provide references for individualized management of similar cases. The case of a 57-year-old male patient with MMTVT, admitted in February 2025, was retrospectively analyzed. The patient presented with left scrotal pain and had a 30-year history of vasectomy. Scrotal ultrasound, testicular MRI and serum tumor marker analyses were performed, followed by local resection of the left tunica vaginalis tumor under spinal anesthesia. Diagnosis was confirmed using postoperative pathology and immunohistochemistry. After comprehensive counseling on recurrence and metastasis risks, the patient and their family declined radical orchiectomy and adjuvant chemotherapy, and close surveillance was instituted. Postoperative pathology confirmed biphasic MMTVT. Immunohistochemistry demonstrated positive mesothelial biomarkers: D2-40(+), calretinin (focal+) and cytokeratin 5/6 (focal weak+). Ki-67 was ~10%, with wild-type p53 expression. The tumor was completely excised with negative margins. No recurrence or metastasis was observed at the 12-month follow-up. This case, presenting with scrotal pain as initial presentation, further highlights the clinical heterogeneity of MMTVT. The remote vasectomy history, which is rarely documented, raises an etiological question for investigation. The biphasic subtype with low Ki-67 suggests that prognostic evaluation requires integrating histological subtype and molecular biomarkers. The 12-month recurrence-free survival time following isolated local excision provides preliminary evidence for organ-sparing management, although long-term outcomes require continued surveillance.

Management of epilepsy requires an individualized, longitudinal approach that incorporates seizure type, recurrence risk, comorbidities, lifestyle, reproductive planning, and safety implications of recurrent seizures. Family physicians play a central role in early counseling, initial medication discussions, monitoring for adverse effects, and recognizing when referral for advanced therapies is warranted. Evidence shows that early initiation of maintenance antiseizure medication after a first unprovoked seizure lowers short-term recurrence but does not change long-term remission or mortality, underscoring the need for shared decision-making grounded in patient preferences and psychosocial or occupational needs. Because epilepsy is increasingly viewed as a heterogeneous group of disorders rather than a single entity, treatment must integrate mechanism-based medication selection, titration principles, therapeutic monitoring, and nonpharmacologic options such as dietary therapy, neuromodulation, and surgery. This section provides a primary care–focused overview of medication strategy, emphasizing when to start medication, how to choose and adjust therapy, and how to manage breakthrough seizures, drug resistance, and pregnancy-related issues.

Microsurgical vasectomy reversal has progressed from bilateral scrotal incisions, through which the testes were delivered, to incisions delivering the vasa, and now to techniques using mini-incisions. We present our technique for microsurgical vasovasostomy via a single keyhole puncture using the no-scalpel vasectomy techniques.

Isolated duplication of the vas deferens is a rare male reproductive system congenital anomaly with an estimated worldwide prevalence of 0.05%. It is often recognized as an incidental finding during surgeries including vasectomy, inguinal hernia repair, orchidopexy, or varicocelectomy. The number of case reports on this condition are very limited suggesting it is either rarer than the reported estimates or highly underrecognized and underreported. Failure to recognize an iatrogenic injury to the vas deferens can lead to postoperative complications including chronic pain, spermatic granuloma, and failure of sterilization after vasectomy. Considering the high number of hernia repair procedures performed worldwide, surgeons should be aware of this anomaly to reduce the risk of complications. Herein, we present a 69-year-old man with an isolated duplicated vas deferens which was discovered during robot-assisted laparoscopic unilateral inguinoscrotal hernia repair.

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.

Despite advances in reproductive medicine, a widely acceptable male contraceptive method is still lacking, leaving the burden of birth control largely on women. As a result, female-centric methods continue to dominate global contraceptive trends, as male options are limited to condoms and vasectomy, both of which are constrained by issues related to reliability, reversibility, or social acceptability. Adoption of novel methods in this regard remains low as well due to social perceptions, myths surrounding masculinity, and concerns regarding side effects. This study was conducted as a narrative literature review to synthesize current scientific, translational, social, and ethical perspectives related to the development of male contraceptive methods. In this narrative review, we have provided a historical record of developments in the field of male contraception, from traditional methods such as condoms and vasectomy to novel hormonal and non-hormonal methods, highlighting major clinical trials along with various scientific, social, economic, ethical, and cultural barriers that impede both the development and acceptance of these novel approaches. In addition, the review explores the role of unequal gender expectations and cultural norms that discourage male participation, and the broad impact of this on reproductive health. Lastly, we discuss how pairing scientific advancements with societal norms and preferences could be pivotal in promoting shared responsibility, equity, and sustainability in reproductive health.

Vasectomy reversal is a technically demanding microsurgical procedure aimed at restoring fertility. Robot-assisted vasovasostomy (RAVV) has been introduced to enhance precision and ergonomics, but robust clinical data remain limited. We report perioperative, functional, and fertility outcomes from one of the largest single-centre series of RAVV and explore patient-related factors associated with postoperative patency. We retrospectively analysed prospectively maintained data from men undergoing bilateral RAVV at a tertiary referral centre between January 2008 and September 2025. All patients had fathered at least one biological child before undergoing vasectomy. Perioperative outcomes, semen parameters, and pregnancy rates were assessed. Functional patency was defined as a postoperative sperm concentration ≥ 1 million/mL. Associations between clinical variables and patency were explored using univariable logistic regression analyses. Sixty men underwent RAVV. Median age at surgery was 42 years (IQR 38-47), and the median interval between vasectomy and reversal was 6 years (IQR 4-9). Median operative and console times were 118 min (IQR 100-132) and 85 min (IQR 70-100), respectively. All patients were discharged on postoperative day 1. Functional patency was achieved in 56 patients (93.3%). Among 44 men attempting conception, 36 (81.8%) achieved spontaneous pregnancy during follow-up. In univariable analysis, active smoking was significantly associated with a reduced likelihood of postoperative patency. RAVV achieved high postoperative patency and favourable pregnancy outcomes in this single-centre cohort, supporting its feasibility in experienced robotic centres. Active smoking was associated with a lower likelihood of patency, although this exploratory finding requires confirmation in larger studies. Comparative studies with conventional microsurgical vasovasostomy are needed to establish the relative clinical value of the robotic approach.