Federico Belladelli

Objective: To assess geographical variation in stretched penile length among prepubertal boys and evaluate temporal trends over the past two decades, as defining reference values for genital organ size remains crucial for early identification of development disorders. Methods: The PubMed, Cochrane and Scopus databases (no deadlines for publishing were imposed) were searched according to the Preferred Reporting Items for Systematic Review and Meta‐analyses statement. Five authors independently extracted individual participant data and assessed the risk of bias. Studies with quantitative penile lengths were included; those involving congenital malformations were excluded. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (registration number CRD42022335643). Results: A total of 55 studies from 2000 to 2024 were evaluated, including data from 31 915 boys. Pooled mean stretched penile length estimates were 3.07 cm (95% confidence interval [CI] 2.88–3.26 cm) for the 1‐week‐old boys, 3.73 cm (95% CI 3.53–3.93 cm) for the 1‐year‐old boys, 4.69 cm (95% CI 4.49–4.88 cm) for the 2–5 year‐old boys, and 5.43 cm (95% CI 5.20–5.66 cm) for the 5–10 year‐ old boys. When comparing data from the 2000s to the 2020s, stretched penile length decreased by 16.2% (from 3.46 to 2.90 cm), 16.3% (from 4.17 to 3.49 cm), 21.5% (from 5.31 to 4.17) and 26.2% (from 6.46 to 4.77 cm) in the 1‐week‐old, 1‐year‐old, 2–5‐year‐old and 5–10‐year‐old boys, respectively. Subgroup analysis for those aged >2 years showed significant variations by geographical region ( P < 0.001). Conclusions: The present study observed large variations in penile length across geographical regions and among prepubescent boys of different ages, while also suggesting a possible decline over the past two decades.

Introduction: Erectile dysfunction (ED) cases can be classified as “primary organic” (PO‐ED) or “primary psychogenic” (PP‐ED) according to the most likely etiology. This study aimed to assess adherence to phosphodiesterase type 5 inhibitor (PDE5i) therapy in men with PP‐ED and PO‐ED. Materials and Methods: We conducted a retrospective analysis of 1252 men presenting with ED as their primary complaint and prescribed a PDE5i. According to the European Association of Urology Guidelines, patients were operationally categorized into two groups based on the presence (≥1) or absence (0) of recognized ED risk factors, in line with EAU guideline definitions (hereafter referred to as PO‐ED and PP‐ED for descriptive purposes). Comorbidities were assessed using the Charlson comorbidity index (CCI). All patients completed the International Index of Erectile Function (IIEF) at baseline and at treatment discontinuation or switch. Adherence was evaluated over 16 years using Kaplan–Meier survival analysis and Cox regression models. Results: Of the 1252 patients, 211 (17%) had PP‐ED and 1041 (83%) had PO‐ED. PP‐ED patients were younger ( p < 0.001) with lower CCI ( p < 0.001), healthier lifestyle habits (less smoking, alcohol use, and lower BMI; p < 0.01), and a more favorable biochemical profile (higher testosterone, lower HbA1c and triglycerides, higher HDL; all p < 0.01). Baseline IIEF domain scores were similar except for IIEF‐OF, which was higher in PP‐ED ( p = 0.007). Overall, 614 (49%) patients discontinued treatment: 95 (45%) with PP‐ED and 519 (49.8%) with PO‐ED. At discontinuation/switch, IIEF scores were comparable except for IIEF‐OF, which remained higher in PP‐ED ( p = 0.033). Adherence was significantly poorer in PO‐ED ( p < 0.001). Cox regression showed that PO‐ED (HR 2.60, 95% CI 1.36–4.98) and sedentary lifestyle (HR 1.51, 95% CI 1.07–2.13) were independent predictors of discontinuation. Conclusions: In this real‐life retrospective study, adherence was lower in patients with an organic risk factor burden compared with those without identifiable risk factors.

Passarelli F, et al. World J Mens Health. 2025 Oct;43:e83. https://doi.org/10.5534/wjmh.250201

PURPOSE: Von Hippel-Lindau (VHL) disease is a rare genetically inherited disorder and represents the most frequent cause of hereditary renal cancer (RC). Depression and quality of life (QoL) are often neglected or underreported issues in individuals affected by VHL disease. We sought to investigate QoL items in patients with VHL disease versus patients with sporadic RC (spRC) in a comparative analysis using patient-reported outcome measures (PROMs). MATERIALS AND METHODS: In an institutional prospective VHL program, 30 VHL patients with RC have been enrolled. The comparator was a cohort of 393 patients surgically treated for spRC. To prospectively evaluate PROMs about depression and sexual functioning, all patients completed the Beck Depression Inventory scale, the Female Sexual Function Index for female, and the International Index of Erectile Function for male patients, respectively. Multivariable linear regression analysis tested the association between VHL disease or spRC and the study outcomes. RESULTS: Overall, 30 (7%) and 393 (93%) patients had VHL disease and spRC, respectively. At multivariable linear regression analysis, patients with VHL disease were more prone to depression according to a higher Beck Depression Inventory score (estimate 8.8; P < .0001); this difference was more pronounced in older patients. Conversely, VHL and spRC groups did not differ in terms of sexual functioning. CONCLUSION: Patients diagnosed with hereditary RC are more prone to depression compared with patients diagnosed with spRC. Conversely, the two groups did not differ in terms of sexual well-being. These novel findings highlight the clinical importance of psychological counseling throughout the management workup of patients with lifelong hereditary disorders.

Introduction: Bladder neck stenosis (BNS) is a known complication following surgery for benign prostatic enlargement (BPE). While endoscopic bladder neck incision (BNI) is considered a viable treatment option, factors leading to success or failure remain not clearly elucidated.Methods: Patients receiving BNI for BNS after BPE surgery were included. International Prostate Symptoms Score (IPSS) was assessed 3 months after BNI. Failure after treatment was defined as IPSS between 8 and 35 points (pts). Logistic regression analyses tested association between BNI failure and predicting factors such as Charlson Comorbidity Index (CCI), time from BPE surgery to onset of BNS symptoms (< 6 vs. ≥ 6 months), prostate volume and BPE surgery technique (holmium [ho] laser enucleation of the prostate [HoLEP] vs. transurethral resection of the prostate [TURP]).Results: Overall, 110 patients underwent BNI. The majority (91.8%) received ho‐laser BNI. Three months after BNI, 64.0%, 30.7% and 5.3% patients reported mild (0–7 pts), moderate (8–19 pts), and severe (20–35 pts) symptoms according to IPSS, respectively. A time < 6 months from BPE surgery to the onset of BNS symptoms (OR: 3.87; 95%CI:1.25–13.00; p = 0.02) and prostate volume < 50 g at BPE surgery (OR: 3.47; 95%CI:1.14–11.59; p = 0.03) were statistically significantly associated with BNI failure.Conclusions: BNI for BNS following BPE surgery is associated with satisfactory outcomes, not influenced by comorbidities and technique for BPE surgery. Short time interval between BPE surgery and onset of BNS symptoms, as well as small prostate volume at BPE surgery seem to increase risk of BNI failure.

Background: Maternal obesity increases offspring obesity risk, but limited data exist on its association with reproductive hormones in infertile males. Objectives: To investigate the impact of maternal obesity during pregnancy on total testosterone levels in primary infertile men. Materials and methods: Data from 418 men seeking medical help for primary infertility were analyzed. Demographics, clinical data, comorbidities, and history of maternal obesity during pregnancy were recorded. Testicular volume was assessed with Prader's orchidometer. Serum hormones, including calculated free testosterone, and semen parameters were collected. Low testosterone and low calculated free testosterone were defined as total testosterone 2 . Men with low testosterone ( n = 69) had higher body mass index, Charlson comorbidity index score, and follicle‐stimulating hormone, but lower testicular volume, sex hormone‐binding globulin, sperm concentration, motility, and normal morphology compared to men without low testosterone (all p < 0.04). Similarly, men with low calculated free testosterone ( n = 226) showed higher sex hormone‐binding globulin, lower estradiol, sperm concentration, and motility than those with normal calculated free testosterone values (all p < 0.02). Low testosterone (7.2% vs. 2.0%, p = 0.01) and low calculated free testosterone (4.4% vs. 1.0%, p = 0.03) were more frequently reported during maternal obesity. Multivariable logistic regression analysis showed that maternal obesity at pregnancy (odds ratio: 5.9), higher body mass index (odds ratio: 1.1), and lower testicular volume (odds ratio: 0.9) were independent predictors of low testosterone (all p < 0.01), adjusting for age. Multivariable linear regression analyses identified maternal obesity at pregnancy ( β = ‒4.1) and lower testicular volume ( β = 1.8) as independent predictors of calculated free testosterone (all p < 0.001), after accounting for age and body mass index. Conclusions: Low testosterone is a frequent characteristic in primary infertile men. Although rare, maternal obesity at pregnancy is significantly associated with reduced total testosterone and calculated free testosterone levels. Further preventive strategies and close follow‐up should be considered in this specific group.

Basran SS, et al. World J Mens Health. 2026 Jan;44:e4. https://doi.org/10.5534/wjmh.250281

Negri F, et al. World J Mens Health. 2024 Nov;42:e102. https://doi.org/10.5534/wjmh.240184

Pozzi E, et al. World J Mens Health. 2024 Jun;42:e63. https://doi.org/10.5534/wjmh.240069