This paper presents a qualitative evidence synthesis investigating men's clinical experiences, psychosocial challenges, and decision-making related to help-seeking and treatment for erectile dysfunction (ED). The findings suggest that ED affects relationship experiences, self-esteem, psychosocial well-being, and help-seeking behaviors. Studies identified through Scopus, PubMed, and PsycINFO were synthesized qualitatively, focusing on adult men's experiences of ED, disclosure, treatment engagement, and decision-making. The review protocol was not prospectively registered. Searches were conducted in March 2026, and the included studies represented diverse clinical contexts, including general ED care, diabetes care, cancer survivorship, and cardiovascular rehabilitation. Eight qualitative studies involving 209 participants were included, and four major themes emerged: masculinity, stigma, and self-silencing; relational consequences influencing help-seeking and disclosure; healthcare communication as a barrier or facilitator to care; and treatment trade-offs, adherence, and acceptability. Men frequently reported negative effects on emotional well-being and help-seeking behaviors due to ED. Delay and hesitation in disclosure and help-seeking were attributed to fear of judgment, lack of support, and negative effects on confidence and self-esteem. Participants valued respectful communication from healthcare professionals and preferred supportive, individualized approaches that included relationship support. Decisions to seek treatment were influenced not only by perceived effectiveness but also by side effects, emotional burden, relationship concerns, and communication experiences. The findings should be interpreted with consideration of the limited number of included studies and the restriction to English-language publications. These findings suggest that ED care should incorporate respectful, stigma-sensitive communication and individualized counseling to facilitate treatment-seeking and improve treatment engagement.

Demand has increased in recent years to develop and implement strategic approaches for improving functional outcomes following pelvic surgery. Intraoperative neurophysiological monitoring represents one such possible approach for this field. It involves generating neuronal activity within the nerve supply of pelvic organs and structures, conventionally using an external electrical current, and conjunctively recording neuronally mediated functional responses, which then, in real time, guides the surgical dissection in a manner that maximizes nerve preservation. A central aspect of this methodology is the creation of a neuronal stimulus. As such, sacral neurostimulation is proposed, strategically exploiting the neuroregulatory influence of the sacral spinal cord in pelvic physiology. While resembling sacral neuromodulation, a distinct methodology designed for long-term reprogramming of neural circuits, sacral neurostimulation aims to produce more immediate nerve signaling effects. Several technical options in this mode of neurostimulation are described, in which stimulatory electrodes are applied transspinally or peripherally to the neural pathways of the sacral spinal cord. These options can be categorized as surgical, percutaneous, and transcutaneous techniques. Ongoing studies in this field may reveal the most applicable techniques and optimal parameters for inducing erections and other neuronally mediated functional responses in the pelvic region as well. In turn, sacral neurostimulation may contribute toward applying neurophysiological monitoring during pelvic surgeries as a potential advance for improving postoperative functional outcomes. This narrative review serves to present the novelty of sacral neurostimulation for intraoperative induction of penile erection and its possible use in intraoperative neurophysiological monitoring for pelvic surgery.

Erectile dysfunction (ED) is closely linked to vascular and metabolic disorders. Magnesium plays a crucial role in endothelial function, inflammation, and metabolism, but the relevance of chronic magnesium depletion to ED remains unclear. The magnesium depletion score (MDS) is a practical marker of long-term magnesium loss. This study examined the association between MDS and ED in United States adults and explored genetic evidence for magnesium metabolism using Mendelian randomization (MR). This cross-sectional study included 3692 men aged ≥ 20 years from National Health and Nutrition Examination Survey 2001 to 2004. MDS was calculated from renal function, diuretic and proton-pump inhibitor use, and alcohol consumption. Survey-weighted logistic regression, subgroup analysis, and restricted cubic splines were used to evaluate the association between MDS and ED, adjusting for demographic, lifestyle, and metabolic factors. Two-sample and multivariable MR analyses assessed genetic evidence for the relationship between magnesium metabolism disorders and ED, with adjustment for body mass index (BMI), type 2 diabetes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Higher MDS was associated with increased odds of ED (fully adjusted odds ratio = 1.40; 95% confidence interval, 1.22-1.61; P = .002). Men with MDS ≥ 2 had more than twice the odds of ED compared with those with MDS < 2. Restricted cubic spline analysis demonstrated a nonlinear relationship, with the risk beginning to rise at approximately an MDS of 1 and increasing sharply when the MDS exceeded 3. Two-sample MR found no direct causal effect of magnesium metabolism disorders on ED. In multivariable MR, magnesium metabolism disorders showed a modest positive association with ED after adjustment for BMI, diabetes, and lipid traits (odds ratio = 1.01; 95% confidence interval, 1.00-1.02; P = .028). Genetically predicted higher BMI and diabetes were also associated with ED. Higher MDS was associated with increased odds of ED in United States adult men. MR findings provided limited but supportive evidence for a role of magnesium metabolism within a broader cardiometabolic context. Overall, MDS may serve as a potential risk marker for ED, but further prospective and interventional studies are needed to confirm its clinical relevance.

Diabetes mellitus‑induced erectile dysfunction (DMED) is a common diabetic complication characterized by endothelial dysfunction and corpus cavernosum (CC) remodeling. Although circular RNAs (circRNAs) have been implicated in diabetic vascular diseases, their roles in DMED remain largely unknown. The present study investigated the biological function and underlying mechanism of circRNA_013145 in DMED. CircRNA microarray analysis identified circRNA_013145 as a significantly upregulated circRNA in penile tissue from DMED rats. Its biological function was evaluated using loss‑of‑function and rescue experiments in high glucose (HG)‑treated CC smooth muscle cells (CCSMCs), human umbilical vein endothelial cells (HUVECs) and a DMED rat model. circRNA_013145 expression was markedly increased in DMED penile tissue and HG‑treated cells. circRNA_013145 knockdown attenuated HG‑induced oxidative stress, inflammation, apoptosis, autophagy and phenotypic transformation, while improving endothelial function and cell viability. Mechanistically, circRNA_013145 served as a molecular sponge for miR‑185‑5p, thereby positively regulating RhoA expression. Rescue experiments demonstrated that inhibition of miR‑185‑5p partially abolished the protective effects of circRNA_013145 knockdown. Furthermore, adenovirus‑mediated knockdown of circRNA_013145 significantly improved erectile function and alleviated cavernosal pathological injury in DMED rats, as evidenced by an increased intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio, enhanced CD31 expression and reduced collagen deposition. In conclusion, circRNA_013145 promotes the progression of DMED through the miR‑185‑5p/RhoA axis. Targeting circRNA_013145 may represent a potential therapeutic strategy for DMED.

Recreational ketamine use is rapidly increasing, and ketamine-induced uropathy (KIU) is gaining recognition for its severe impact on quality of life (QoL), including pain, hematuria, lower urinary tract symptoms (LUTS), and potential negative effects on sexual function. This study investigates the prevalence of sexual dysfunction among men with KIU.

This single-center retrospective study analyzed the degree of association between urinary symptom improvement and erectile or ejaculatory function change in patients after prostatic artery embolization (PAE) for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urinary symptom severity (IPSS), erectile function (SHIM), and ejaculatory function (MSHQ-EjD) were assessed at baseline, 3 months, and 12 months after PAE. Among the 183 patients treated from 2014 to 2023, mean IPSS improved by 12.0 points. After adjustment for age, baseline score, medications, and vascular comorbidities, urinary-score change was associated with erectile-function-score change at the first (partial r = -0.17; P = .025) and second follow-up (partial r = -0.25; P = .020), strengthening in the baseline erectile-dysfunction subgroup (partial r = -0.38; P = .008). Strong urinary responders more often achieved the erectile-function minimal clinically important difference (26.3% vs 3.8%; P = .014). No significant association was found with ejaculatory function.

Transurethral ultrasound ablation (TULSA) of the prostate is an innovative, minimally invasive, incision- and radiation-free procedure guided by MRI. Early clinical data suggest TULSA is associated with lower rates of common postoperative complications including urinary incontinence and erectile dysfunction. Its minimally invasive profile makes it especially suitable for elderly patients and those with elevated medico-surgical risks. We report the anaesthetic management of the first MRI-guided TULSA procedure performed in Southeast Asia on an elderly male patient in his 80s with prostatic adenocarcinoma. General anaesthesia was administered using a balanced technique combining low-dose volatile agent with continuous infusions of remifentanil and rocuronium. This approach ensured stable haemodynamics, adequate sedation and complete immobility throughout the procedure. To date, there are no established anaesthetic protocols for TULSA. Our experience demonstrates that the essential goals of immobility, sedation and rapid recovery can be effectively achieved.