Introduction: Artificial Intelligence (AI) has witnessed significant growth in the field of medicine, leveraging machine learning, artificial neuron networks, and large language models. These technologies are effective in disease diagnosis, education, and prevention, while raising ethical concerns and potential challenges. However, their utility in sexual medicine remains relatively unexplored. Objective: We aim to provide a comprehensive summary of the status of AI in the field of sexual medicine. Methods: A comprehensive search was conducted using MeSH keywords, including "artificial intelligence," "sexual medicine," "sexual health," and "machine learning." Two investigators screened articles for eligibility within the PubMed and MEDLINE databases, with conflicts resolved by a third reviewer. Articles in English language that reported on AI in sexual medicine and health were included. A total of 69 full-text articles were systematically analyzed based on predefined inclusion criteria. Data extraction included information on article characteristics, study design, assessment methods, and outcomes. Results: The initial search yielded 905 articles relevant to AI in sexual medicine. Upon assessing the full texts of 121 articles for eligibility, 52 studies unrelated to AI in sexual health were excluded, resulting in 69 articles for systematic review. The analysis revealed AI's accuracy in preventing, diagnosing, and decision-making in sexually transmitted diseases. AI also demonstrated the ability to diagnose and offer precise treatment plans for male and female sexual dysfunction and infertility, accurately predict sex from bone and teeth imaging, and correctly predict and diagnose sexual orientation and relationship issues. AI emerged as a promising modality with significant implications for the future of sexual medicine. Conclusions: Further research is essential to unlock the potential of AI in sexual medicine. AI presents advantages such as accessibility, user-friendliness, confidentiality, and a preferred source of sexual health information. However, it still lags human healthcare providers in terms of compassion and clinical expertise.

This study aims to evaluate the association between antimicrobial practices, including oral antibiotics, intravenous antibiotics, antifungal prophylaxis, and infection outcomes in patients undergoing primary or revision inflatable penile prosthesis surgery. We conducted a multicenter, retrospective cohort study of 5,261 patients who underwent primary or revision inflatable penile prosthesis surgery at 16 specialized centers across the United States, Europe, and Korea from July 2016 to July 2021. Patient data included demographic and clinical characteristics, antibiotic and antifungal administration, and infection outcomes. The primary outcome was infection following inflatable penile prosthesis placement. Univariable and multivariable regression analyses were performed to identify predictors of infection. The overall infection rate was 1.9% (n=102), with higher rates among diabetic patients (p=0.023), those with prior inflatable penile prosthesis infection (p<0.001), or undergoing revision surgery (p<0.001). Multivariable analysis identified diabetes (OR=1.68, p=0.022) and previous inflatable penile prosthesis infection (OR=4.67, p<0.001) as independent risk factors for infection. Perioperative intravenous antifungal use was significantly associated with a lower infection risk (OR=0.22, p24 hours) (p=0.2) did not demonstrate protective effects. Pre- and postoperative oral antibiotics were not associated with a statistically significant reduction in infection after adjustment for confounding variables. This large multicenter study highlights a significant association between perioperative antifungal prophylaxis and lower infection risk in inflatable penile prosthesis surgery while demonstrating the limited utility of preoperative and postoperative oral antibiotics and prolonged intravenous prophylaxis. These findings support evidence-based antimicrobial stewardship to optimize outcomes and minimize complications, including antibiotic resistance.

Ischemic priapism is a urological emergency which may lead to irreversible erectile dysfunction. One of the accepted treatments is penile prosthesis implantation. Given the scarcity of studies directly comparing timing of penile prosthesis insertion after ischemic priapism, consensus remains elusive. We aim to compare different studies in the literature concerning advantages and disadvantages of early versus delayed inflatable penile prosthesis following ischemic priapism. We analyzed 8 articles that investigated immediate and delayed inflatable penile prosthesis placement after ischemic priapism. Early inflatable penile prosthesis placement is associated with better outcomes, including pain relief, priapism resolution, penile shortening prevention, and quicker sexual activity resumption. However, it still carries a high risk of complications like edema, infection, and distal perforations. Delayed inflatable penile prosthesis insertion poses surgical challenges due to the potential for extensive corporal fibrosis. Comparative analyses have shown elevated complication rates in patients with ischemic priapism who undergo delayed inflatable penile prosthesis insertion, as opposed to those with early insertion. In studies reporting complications rates, the total complication rate in the early group was 3.37%, significantly lower than the delayed group (37.23%). Most studies support the superiority of early inflatable penile prosthesis placement following ischemic priapism over delayed placement. Further research is, however, needed to establish a global consensus on timing of prosthesis insertion.

Background: Peyronie’s disease (PD) involves the formation of fibrous scar tissue in the penis, causing pain, deformity, and significant psychological and sexual distress. Intralesional injection of collagenase Clostridium histolyticum (CCH) has emerged as a promising non-surgical treatment, though patients may experience complications and require multiple clinic visits. Aim: This study aims to evaluate patient compliance with CCH therapy, compare outcomes between compliant and non-compliant groups, and identify reasons for non-compliance. Methods: This IRB-approved retrospective study analyzed patients with PD between 2017 and 2023. Patients were evaluated by a fellowship-trained andrologist. Patients who elected to have intralesional CCH were initially offered four cycles of treatment, with compliance defined as completing at least four cycles or achieving satisfactory results with fewer cycles. Outcomes: Data on demographics, disease characteristics, treatment modalities, compliance, and outcomes were extracted from electronic medical records, and causes of non-compliance were identified. Outcomes and complications were compared between compliant and non-compliant groups. Results: Two hundred and ninety-two PD patients elected to have an intralesional injection of collagenase CCH. Among these, 51.4% completed four treatment cycles, 14.7% received more than four cycles, and 33.9% received fewer than four cycles. The overall compliance rate for injection therapy, including those satisfied with fewer cycles, was 70.89%. Mean pre-treatment curvature for 292 patients was 46.77 ± 14.26 degrees. Compliant patients showed a greater percent of curvature reduction (median 44.44 (IQR 34.17) vs 33.33 (IQR 44.17), P = .034) and less post-treatment curvature in degree (median 25.00 (IQR 17.02) vs 30.00 (IQR 23.75), P = .032) compared to non-compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%). Clinical Implications: Compliance with CCH therapy for PD significantly impacts treatment outcomes. Healthcare providers should address factors contributing to non-compliance. Qualitative studies are recommended to gain deeper insights into non-compliant patients. Strengths and Limitations: This study analyzed compliance in a large cohort of PD patients and compared outcomes between compliant and non-compliant groups. However, missing data in the non-compliant group and the bias between compliant and non-compliant patients in this retrospective study are major notable limitations. Conclusion: Overall compliance rate for CCH injection therapy was 70.89%. Greater curvature reduction was demonstrated in compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%). However, missing data and bias from retrospective design are major limitations.

Background: Radical cystectomy (RC) is considered a complex procedure that entails significant morbidity and mortality. Objectives: We aimed to determine pre-operative patient characteristics that help predict a prolonged length of hospital stay (PLOS) following RC. Design and Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was used to select patients who underwent RC between the years 2011 and 2020. Prolonged length of stay was defined as a hospital stay ⩾9 days. We compared patient demographics, pre-operative labs, surgical characteristics, and medical history between patients with or without PLOS. Multivariable logistic regression models controlling for pre-operative characteristics and propensity score matching for post-operative complications were conducted to control for possible confounders. Results: The analysis yielded details of 19,158 RC patients of which 6007 (31%) patients had a PLOS. Patients with PLOS were more likely to have post-operative complications that could serve as predictors for the PLOS rather than their pre-operative characteristics. Hence, we matched our cohort for these complications. After matching, patient pre-operative characteristics that predict PLOS included female gender (Odds Ratio (OR) = 5.91), 10-year increase in age (OR = 1.15), non-White race (OR = 1.98), partially or totally dependent functional health status (OR = 2.86), bleeding disorders (OR = 4.67), congestive heart failure (OR = 1.59), pre-operative transfusion (OR = 3.03), and a 20-min increase in operative time (OR = 1.01) ( p < 0.046). Conclusion: Patient demographics and pre-operative factors can help predict PLOS in RC patients. These predictors could serve as tools for patient counseling and risk stratification.

Introduction: Erectile dysfunction (ED) is a prevalent condition with multifactorial etiology and significant impact on men’s quality of life. Although standard therapies—such as phosphodiesterase type 5 inhibitors, vacuum devices, and penile prostheses—offer symptomatic relief, they do not address the underlying pathophysiology. Platelet-rich plasma (PRP), an autologous concentration of platelets and growth factors, has emerged as a potential regenerative treatment that may promote neurovascular repair and restore erectile function. Aim: To evaluate the efficacy and safety of PRP monotherapy for the treatment of erectile dysfunction through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Google Scholar, Cochrane Library, Scopus, and Web of Science was performed for RCTs assessing intracavernosal PRP injections in men with ED. Studies combining PRP with other regenerative therapies were excluded. Data were synthesized using a random-effects model to generate pooled standardized mean differences (SMDs) in International Index of Erectile Function (IIEF) scores at 1, 3, and 6 months. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Seven RCTs including 512 participants were analyzed. PRP injection volumes ranged from 5 to 10 mL across 2-4 sessions. At 1 month, pooled SMD in IIEF was 0.28 (95% CI −0.11 to 0.67, P = .16); at 3 months, it was 0.29 (95% CI −0.08 to 0.67, P < .05); and at 6 months, it was 0.36 (95% CI −0.09 to 0.81, P = .12). Heterogeneity was high (I2 = 74%-83%) across time points. Subgroup analyses showed no significant difference by risk of bias. PRP was well tolerated, with only isolated mild adverse events (hematoma, plaque formation) reported. Conclusion: Current evidence does not support a consistent, clinically meaningful improvement in erectile function with PRP monotherapy compared with placebo. Despite an encouraging mechanistic rationale and safety profile, the high heterogeneity, small sample sizes, and methodological limitations of existing RCTs limit confidence in efficacy. Larger, standardized, double-blind trials with rigorous protocols are needed to clarify the role of PRP in ED management.