Despite early detection and regular surveillance of non-muscle invasive bladder cancer (NMIBC), recurrence and progression rates remain exceedingly high for this highly prevalent malignancy. Limited visualization of malignant lesions with standard cystoscopy and associated false-negative biopsy rates have been the driving force for investigating alternative and adjunctive technologies for improved cystoscopy. The aim of our systematic review and meta-analysis was to compare the sensitivity, specificity, and oncologic outcomes of photodynamic diagnosis (PDD) fluorescence, narrow band imaging (NBI), and conventional white light cystoscopy (WLC) in detecting NMIBC. Out of 1,087 studies reviewed, 17 prospective non-randomized and randomized controlled trials met inclusion criteria for the study. We demonstrated that tumor resection with either PDD and NBI exhibited lower recurrence rates and greater diagnostic sensitivity compared to WLC alone. NBI demonstrated superior disease sensitivity and specificity as compared to WLC and an overall greater hierarchical summary receiver operative characteristic. Our findings are consistent with emerging guidelines and underscore the value of integrating these enhanced technologies as a part of the standard care for patients with suspected or confirmed NMIBC.

Prostate-specific antigen (PSA) testing as the sole indication for prostate biopsy lacks specificity, resulting in overdiagnosis of indolent prostate cancer (PCa) and missing clinically significant PCa (csPCa). SelectMDx is a biomarker-based risk score to assess urinary HOXC6 and DLX1 mRNA expression combined with traditional clinical risk factors. The aim of this prospective multi-institutional study was to evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) when predicting PCa in prostate biopsies. Overall, 310 consecutive subjects were included. All patients underwent mpMRI and SelectMDx prior to prostate biopsy. SelectMDx and mpMRI showed sensitivity and specificity of 86.5% vs. 51.9%, and 73.8% vs. 88.3%, respectively, in predicting PCa at biopsy, and 87.1% vs. 61.3%, and 63.7% vs. 83.9%, respectively, in predicting csPCa at biopsy. SelectMDx was revealed to be a good predictor of PCa, while with regards to csPCa detection, it was demonstrated to be less effective, showing results similar to mpMRI. With analysis of strategies assessed to define the best diagnostic strategy to avoid unnecessary biopsy, SelectMDx appeared to be a reliable pathway after an initial negative mpMRI. Thus, biopsy could be proposed for all cases of mpMRI PI-RADS 4–5 score, and to those with Prostate Imaging-Reporting and Data System (PI-RADS) 1–3 score followed by a positive SelectMDx.

Background: With the rapid advancement of artificial intelligence (AI), its applications in andrology are expanding across diagnostic assessment, preoperative planning, intraoperative assistance, and postoperative management. This narrative review aims to synthesize current evidence regarding AI applications across the spectrum of andrological surgery. Methods: A comprehensive literature search was conducted using the PubMed, Scopus and Web of Science databases to identify relevant studies published between January 2020 and October 2025. The search strategy utilized combinations of keywords including “artificial intelligence,” “andrology,” “erectile dysfunction,” “male infertility,” “microsurgery,” and “robotic-assisted surgery.” Original research and review articles published in English were selected based on their clinical relevance to surgical practice. Results: AI has shown promise in the evaluation and management of erectile dysfunction (ED), male infertility-related microsurgery, and complex reconstructive procedures. AI-based models can improve risk prediction and diagnosis of ED, standardize semen analysis, support individualized selection of surgical candidates for varicocele repair and other interventions, and augment microsurgery through enhanced visualization and decision support. In the postoperative phase, AI-driven tools are being explored for complication prediction, functional recovery monitoring, and long-term quality-of-life follow-up, enabling more patient-centered, continuous care. Conclusions: AI holds significant promise for advancing precision medicine in andrological surgery by enhancing objective assessment and intraoperative guidance. However, large-scale, standardized datasets and rigorous multi-institutional validation are needed. Establishing robust ethical and legal frameworks will be essential to ensure the safe and effective integration of AI into routine andrological care.

Background and Objectives: Psychogenic erectile dysfunction (ED) is a distinct clinical condition characterized by predominant psychological or relational factors. Despite its prevalence, diagnostic criteria remain heterogeneous and are often based on exclusion of organic causes. Current guidelines recommend cognitive behavioral therapy (CBT), eventually combined with medical therapy such as phosphodiesterase type 5 inhibitors (PDE5i), as first-line treatment. However, evidence regarding alternative conservative and surgical therapies remains limited. This narrative review aims to evaluate the available evidence on these treatments in psychogenic ED. Materials and Methods: A comprehensive literature search was conducted in PubMed, Scopus, and MEDLINE using MeSH terms and free-text keywords related to psychogenic ED and therapeutic interventions. Eligible studies included those involving human subjects, published in English, and reporting outcomes specifically for psychogenic or non-organic ED. Reviews, case reports, and non-full-text articles were excluded. Study selection and data extraction were performed independently by two authors. Due to heterogeneity, a narrative synthesis was conducted. Results: Evidence on alternative therapies is limited and heterogeneous, with many studies predating the 2000s. Vacuum erection devices (VEDs) may improve outcomes, particularly when combined with psychotherapy. Constriction rings showed promising preliminary results. Acupuncture demonstrated inconsistent efficacy, although recent randomized trials suggest potential benefits. Intracavernosal injections (ICI) showed favorable outcomes, particularly in patients refractory to first-line therapies, with some reports of restored spontaneous erections. Penile prosthesis (PP) implantation remains underexplored in contemporary literature on psychogenic ED; however, recent evidence reports good satisfaction rates. Conclusions: Beyond CBT and PDE5i, evidence for alternative treatments in psychogenic ED is scarce and methodologically limited. Selected patients may benefit from adjunctive therapies, including VED, ICI, and acupuncture, while PP can be considered a definitive treatment option. Further well-designed studies are needed to clarify their role within a structured, evidence-based management approach.

Objective: To provide an updated national overview of the clinical management of congenital and acquired penile curvature (PC) in Italy, evaluating current diagnostic and therapeutic practices among Italian urologists.Materials and methods: A 23-item anonymous digital survey was distributed by the Italian Society of Urology (SIU) to 2034 affiliated urologists between 2024 and 2025. The survey includes demographic data, diagnostic approaches, and treatment strategies for PC, including Peyronie’s disease (PD). Participants were categorized by practice setting and geographic region. SPSS software was used to conduct descriptive and comparative analyses.Results: Overall, 442 urologists had completed the survey (response rate: 21.7%). Most participants were affiliated either with university hospitals (34.6%) or public non-university hospitals (32.8%). The major incidence of PD cases, as reported by 310 (70.1%) respondents, were in patients between 45-60 years old and the most frequent presentation was a dorsal curvature (223 responses, 50.5%). The routine clinical practice, as reported by respondents, includes anamnestic data with photographs collection and penile ultrasound (in 261 (59%) and 188 (42.5%) of respondents, respectively), while penile dynamic CCDU was mainly used in patients with erectile dysfunction. In regard to therapeutic strategies, 142 (32.8%) of urologists used Clostridium Collagenase Histolyticum (CCH) for intralesional therapy; a similar proportion used verapamil/nicardipine, despite limited supporting evidence. Interestingly, surgical approaches varied widely: tunica plication was preferred in non-complex cases by 169 (38.2%), while penile prosthesis was offered in complex cases by 129 (29.2%) urologists. Finally, penile prosthesis implantation was offered in patients with severe ED unresponsive to pharmacological therapy, regardless of penile curvature only by 176 respondents (39.8%), meanwhile, 177 respondents considered penile prothesis only for severe PC over >60 degrees associated with ED.Conclusions: This nationwide survey reveals a significative heterogeneity in PC and PD management in Italy, with frequent reliance on off-label treatments and variable adherence to international guidelines. Economic limitations and regional differences appear to be a primary factor influencing clinical decisions and clinical practice. These findings underline the need for a major dissemination of evidence-based guidelines associated with national healthcare strategies aimed at standardized care and improving patient outcomes.