Tet Yap

Objective: To develop and evaluate an artificial intelligence (AI)‐assisted, multimedia journal club model that improves accessibility by transforming scientific articles into on‐demand educational formats distributed through digital platforms. Subjects and Methods: This prospective single‐centre educational evaluation was conducted at King's College Hospital (London). Six AI‐enhanced journal club sessions were implemented between June and September 2025. Peer‐reviewed urology articles were processed using AI‐assisted tools to generate podcasts, slide presentations, short‐form video summaries, question‐and‐answer materials, and visual infographics. Content was distributed through clinician‐facing platforms including YouTube, Spotify, and social media. Two surveys evaluated educational impact: a format‐specific survey completed by 48 participants and a second survey assessing overall perceptions of the AI‐enhanced journal club completed by 19 participants. Results: The AI‐generated podcast was the most preferred format (62.5%), followed by video summaries (16.7%) and slide presentations (8.3%). Participants reported greater engagement compared with traditional journal clubs, with 54.2% selecting the response option ‘much more engaged’. Format‐specific ratings were consistently high, particularly for podcasts (mean [standard deviation, SD] score for engagement 4.6 [0.6] and for clarity 4.8 [0.5]). In the second survey, overall ratings of the AI‐enhanced journal club were high across all domains, including engagement (mean [SD] score 4.8 [0.4]), clarity (mean [SD] score 4.8 [0.5]), time efficiency (mean [SD] score 4.7 [0.6]), and overall preference (mean [SD] score 4.9 [0.3]). Conclusion: An AI‐assisted, multimodal journal club integrating podcasts, slides, and digital dissemination was associated with improved participant‐reported engagement and accessibility. This scalable model supports asynchronous learning and may complement traditional journal club formats in postgraduate medical education.

Introduction: Infertility is a common consequence of Klinefelter syndrome (KS/XXY), which is often undiagnosed until adulthood and is frequently uncovered during fertility investigations through semen analysis and genetic karyotyping. Aims: To gain insights into the experience of receiving a KS/XXY diagnosis during fertility investigations. Methods: A phenomenological thematic analysis was conducted using interviews with five adults with KS/XXY, selected from a larger cohort of people with KS/XXY because they had experienced infertility. Results: Of the five participants, three described receiving their KS/XXY diagnosis as part of fertility investigations. The thematic analysis identified two themes: ‘finding out’ and ‘emotional reactions’. The ‘finding out’ theme illustrated how people learnt about their infertility and, in some cases, discovered their KS/XXY diagnosis simultaneously. The ‘emotional reactions’ theme captured people’s feelings on being informed of their KS/XXY status and learning that this was the cause of their infertility, activating feelings that some of the participants found hard to process. Conclusions: The findings provide insights into the psychological impact of a sudden combined diagnosis of infertility and KS/XXY, including emotional burden, delayed diagnosis and lack of psychological support. They highlight the importance of earlier detection of KS/XXY where possible and suggest that practitioners in fertility services should handle the delivery of such news with sensitivity.

Objective: To conduct a systematic review and meta‐analysis to indirectly compare the diagnostic performance of contrast‐enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) in the evaluation of indeterminate testicular lesions and to explore their potential roles in guiding clinical decision‐making. Methods: PubMed, Web of Science, and Scopus were searched in August 2025. Eligible studies were prospective or retrospective cohorts evaluating CEUS or MRI in small, impalpable, or incidentally detected testicular lesions, with histopathology or clinical/radiological follow‐up as reference standard. Two reviewers independently performed selection, data extraction, and Quality Assessment of Diagnostic Accuracy Studies‐2 tool assessment. Random‐effects meta‐analyses and meta‐regression were conducted in R (R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria). This review was registered in the Prospective Register of Systematic Reviews (CRD420251113920). Results: A total of 12 studies including 912 patients with 920 lesions (279 malignant, 641 benign) were analysed. CEUS showed a sensitivity of 90% (95% confidence interval [CI] 80–95%) and specificity of 74% (95% CI 47–91%), while MRI achieved a sensitivity of 94% (95% CI 88–97%) and specificity of 84% (95% CI 72–91%). CEUS provided a higher negative predictive value (NPV; 96% vs 88%), whereas MRI demonstrated superior positive predictive value (PPV; 83% vs 65%) and accuracy (91% vs 80%). Differences in PPV and accuracy significantly favoured MRI ( P = 0.025 and P = 0.031). Limitations included protocol heterogeneity, operator dependence, and small sample sizes. Conclusion: Both CEUS and MRI demonstrated a high sensitivity and NPV, supporting their role in excluding malignancy. CEUS, with accessibility, low cost, and particularly high NPV, may serve as the first‐line adjunct, while MRI is best reserved for equivocal or higher‐risk cases. No funding was received for this study.

Objectives: To evaluate the clinical necessity and optimal pharmacological strategy for post‐cycle therapy (PCT) in recreational anabolic‐androgenic steroid (AAS) users with normal pre‐cycle reproductive profiles. Subjects and Methods: This retrospective, dual‐centre cohort study included 79 males who had completed ≤6 months of AAS use and had documented normal pre‐cycle reproductive hormone levels and semen parameters. Participants were managed with no treatment (NT; expectant monitoring), clomiphene citrate (CC) monotherapy (25 mg/day; selective oestrogen receptor modulation to stimulate gonadotrophin release), or CC + human chorionic gonadotrophin (hCG) (25 mg/day CC + hCG 1500 IU subcutaneously three times weekly; rapid androgen repletion and testicular stimulation). In patients with follicle‐stimulating hormone (FSH) <1.5 IU/L, recombinant FSH (rFSH; 75 IU subcutaneously three times weekly) was suggested to promote spermatogenesis. Linear mixed models and logistic regression analyses were used to evaluate group differences and predictors of recovery. Results: At baseline (T0), 89.9% of patients had erectile dysfunction and 69.7% exhibited azoospermia or severe oligozoospermia. Both pharmacological regimens accelerated hormonal recovery vs NT, with normalisation across groups by Month 6. Seminal recovery was significantly earlier in treated groups: at 12 months (T12), normozoospermia rates were 87.5% in CC + hCG, 69.2% in CC, and 58.6% in NT. Testicular volume increased ≥20% in 70.8% of CC + hCG vs 6.9% of NT. Combined therapy independently predicted normozoospermia (odds ratio [OR] 6.23, 95% confidence interval [CI] 1.32–29.4) and motility recovery (OR 4.85, 95% CI 1.27–18.4). All five men receiving rFSH achieved normozoospermia by T12. Sexual function improved across groups, with faster recovery in treated patients. Conclusion: Spontaneous hormonal recovery occurs within 6–12 months after AAS cessation, yet PCT facilitates earlier hormonal normalisation. The addition of hCG to CC was associated with superior recovery of semen parameters and testicular volume. These findings underscore the potential short‐term benefits of PCT and highlight the need for prospective randomised trials to establish evidence‐based treatment protocols.

Sleep Related Painful Erections (SRPE) are parasomnias exclusive to Rapid Eye Movement (REM) sleep, causing sleep disturbances, daytime fatigue, and impaired quality of life. Due to a lack of standardized management, we developed a diagnostic and treatment pathway for this rare condition at our institution. Patients diagnosed with SRPE from 2017–2024 by strict criteria were recruited into our novel pathway. This included a comprehensive diagnostic panel to exclude potential confounding causes of penile pain through history, clinical examination, laboratory tests and imaging studies. Once SRPE is diagnosed a stepwise approach of initiating Baclofen (10 mg daily at night), followed by polysomnography (PSG) (to explore sleep architecture and implement sleep medication and/or treat obstructive sleep apnoea accordingly) and pelvic floor physiotherapy (PFP) (to target pelvic floor hypertonicity). Symptoms were evaluated using a dedicated questionnaire during clinic follow-up. Patients achieving a symptom-free period of >6 months were discharged. Twenty patients with SRPE (mean age 46.2 ± 11.6 years) were included. The mean delay to referral was 3.5 ± 3.1 years, with a mean of 3.3 ± 2.1 SRPE episodes per night (range 1–7) lasting 33 ± 23.7 minutes. 85% of patients completed most of the pathway. Baclofen was administered to 17 patients (10–80 mg at night), 17 underwent PSG, and 9 had PFP assessment. Baclofen benefited 70.6% of patients: 35.3% managed with Baclofen alone, 52.9% required additional sleep medication, and Baclofen was replaced by Etilefrine (5–15 mg at night) in 11.8%. PSG findings included fragmented sleep (76.5%), REM sleep abnormality (47.1%), and mild sleep apnoea (41.2%). Among those assessed for PFP, 66.6% had abnormal pelvic floor muscle tone and initiated PFP. After 3.5 ± 1.9 years of follow-up, 45% were successfully discharged and 55% are still on follow-up and experienced symptom improvement. This multimodal pathway offers a promising framework for managing SRPE.

Seminal oxidative stress (OS) is a major contributing factor to male infertility. Semen analysis cannot identify reactive oxygen species (ROS), which can be measured using a chemiluminescence assay. Measurement of redox potential provides a more comprehensive assessment of OS, although the test has yet to be fully validated. This study aimed to validate the MiOX^sys analyser for measuring static oxidation–reduction potential (sORP). Results demonstrated that duplicate measurements must be taken, sensors must be batch tested, and sockets should be regularly changed to avoid inconsistency in measurement. Measurement of sORP using MiOX^sys exhibited good reproducibility across different operators (p = 0.469), analysers (p = 0.963) and days (p = 0.942). It is not affected by mechanical agitation (p = 0.522) or snap freezing and thawing (p = 0.823). The stability of sORP over time requires further verification, particularly in samples with high initial sORP. Measurement is temperature sensitive between 2 and 37°C, significantly increasing with increasing temperature (p = 0.0004). MiOX^sys is a more stable assay for assessing OS than chemiluminescence methods and permits greater flexibility for sample handling. MiOX^sys could be implemented to complement semen analysis as part of routine diagnostic testing for male infertility and may be useful in identifying contributing factors to idiopathic infertility.