Background/Objectives: To examine whether extending sexual arousal through lengthened erotic video viewing during semen collection improves semen parameters in infertile men. Methods: In this prospective within-subject study, 205 infertile men supplied semen samples in two sessions about four weeks apart and followed strict uniform protocols. In the first session, participants ejaculated after the customary viewing length of erotic videos. During the second session, viewing time was increased prior to ejaculation. Semen volume, sperm concentration, total motility, progressive motility, and morphology were assessed as per the WHO 2021 guidelines. Comparisons were analyzed using paired samples t-test or Wilcoxon signed-rank test and correlation analysis was performed using Spearman’s rank correlation. Results: Median duration of erotic video watching increased from 8 min (IQR: 5–10) to 15 min (IQR: 11–20) (p < 0.001). Moreover, extended arousal was associated with increased sperm concentration (from 19 × 10⁶/mL to 24 × 10⁶/mL, p < 0.001), total motility (43% to 46%, p < 0.001), and progressive motility (33% to 37%, p < 0.001) with unchanged morphology (p = 0.053). Increases in arousal duration exhibited a weak but significant correlation with changes in concentration (ρ = 0.21, p = 0.003), total motility (ρ = 0.27, p < 0.001), and progressive motility (ρ = 0.22, p = 0.002). Subgroup analysis showed improvements in non-smokers but not in smokers. Conclusions: Extended erotic stimulation during semen sample collection significantly enhances sperm motility and modestly increases concentration in men with infertility, albeit without changing morphology. These findings suggest that extended erotic stimulation during semen collection may be a simple, non-invasive strategy to help optimize semen quality in infertile men, especially non-smokers.

Background/Objectives: Adherent perinephric fat (APN) is common in laparoscopic partial nephrectomy (LPN). It is absent from the lists of recognised positive surgical margin (PSM) predictors. We tested whether APN is associated with PSM risk and whether the effect varies by resection technique. Methods: We analysed 401 International Society of Urological Pathology (ISUP)-gradable renal cell carcinomas (31 PSM events; chromophobe RCC was excluded from the primary cohort because the WHO/ISUP grade is not assignable) carried out at three centres by eight surgeons from 2013 to 2024. Nested logistic models added APN, then an APN × enucleation interaction, to a guideline-based covariate set (tumour size, ISUP grade ≥ 3, cT1b stage, centre fixed effects, surgeon-documented enucleation). Firth penalisation and a 2000-replicate bootstrap were used to limit small-sample bias; they cannot add information beyond the 31 observed events. Results: APN was an independent PSM predictor (adjusted odds ratio [OR] 2.68, 95% confidence interval [CI] 1.21 to 5.95, p = 0.02). The effect was technique-conditional: APN × enucleation interaction OR 7.83 (95% CI 1.08 to 56.92, p = 0.04), consistent in direction across estimators but imprecise in magnitude. PSM occurred in 29.4% of APN-positive enucleation cases (odds ratio 10.21, 95% CI 2.07 to 50.30; Fisher exact p = 0.003), against 5.0% in enucleoresection and 10.8% in resection. Conclusions: In this cohort the APN-to-PSM association was technique-conditional. The penalty concentrates in enucleation; the rim-retaining strata gave estimates compatible with both no association and clinically important harm (OR 0.99 and 1.96, both intervals wide). Because the interaction rests on few margin events and the technique was not randomised, this finding is hypothesis-generating: when APN is encountered intraoperatively, retaining a parenchymal rim (enucleoresection or resection) rather than enucleation may be considered, pending prospective validation.

Objective: This study aimed to evaluate the effects of video-based preprocedural patient education and intraoperative virtual reality (VR) support on pain intensity (VAS) and willingness to undergo repeat biopsy (WtR) in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: The data of 240 patients who underwent their first TRUS-guided prostate biopsy for suspected prostate cancer between January 2023 and August 2025 were retrospectively analyzed. Patients were divided into one of four groups based on whether they received preprocedural video education and whether they wore VR headsets during the procedure. The primary endpoint was the pain level during biopsy (VAS), and the secondary endpoint was willingness to undergo a repeat biopsy under the same conditions (WtR). Results: Pain intensity (VAS) and willingness-to-repeat (WtR) scores differed significantly among the four groups (both p < 0.001), with the Video + VR group showing the lowest mean VAS score (2.63 ± 1.31) and the highest mean WtR score (8.25 ± 0.98), while the control group had the highest VAS (4.03 ± 1.62) and the lowest WtR (6.92 ± 1.03). Overall complication rates were low and similar between groups (4.6%, p = 0.343). Conclusion: Video-based preprocedural education combined with real-time VR support during TRUS-guided biopsy significantly reduces pain and increases patients’ willingness to undergo a repeat procedure. This non-invasive, low-cost, and easily applicable alternative represents an effective strategy to improve patient experience.

This study aimed to investigate the effects of pre-procedural video education and intra-procedural distraction using virtual reality (VR) nature videos on patient anxiety and pain perception during office-based flexible cystoscopy. In this single-center, four-arm, parallel-group randomized controlled trial, 240 adult patients scheduled for flexible cystoscopy were enrolled. Participants were randomized into four groups: Video + VR- (n = 60), Video + VR + (n = 60), Video- VR + (n = 60), and Video- VR- (control, n = 60). Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI), and pain was measured with a visual analog scale (VAS). Intergroup comparisons were performed using nonparametric tests, and outcome assessors were blinded to group allocation. Pain scores differed significantly among groups (H = 44.604, p < 0.001). The lowest pain scores were observed in the Video + VR + group (4.3 ± 1.1), while the highest were in the control group (5.7 ± 1.1). Reductions in STAI-S (state anxiety) scores also showed significant group differences (H = 28.311, p < 0.001). Compared with the control group, the Video + VR + group demonstrated significant improvements in both VAS (p < 0.001, r = 0.610) and STAI-S reduction (p < 0.001, r = -0.493), with large effect sizes. Analyses based on baseline STAI-T (trait anxiety) scores indicated that the interventions were effective regardless of initial anxiety levels, with the combined Video + VR + approach consistently providing the greatest benefit. The combination of pre-procedural video education and intra-procedural VR distraction was associated with the greatest reduction in pain and anxiety during flexible cystoscopy. These findings support the potential value of multimodal approaches for improving patient comfort during urologic procedures. Registered on 05 September 2025 in the ISRCTN registry (ISRCTN22513446).

Objective: YouTube has become an increasingly important platform for surgical education; however, the quality of laparoscopic surgery videos is variable. The LAParoscopic Surgery Video Educational Guidelines (LAP-VEGaS) provides a standardized framework for assessing surgical video quality. Material and Methods: A systematic search was conducted on YouTube using relevant search terms. English-narrated laparoscopic radical nephrectomy videos were included. Each video was evaluated using the 9-item core LAP-VEGaS checklist. Results: Twenty-one videos were included. The mean LAP-VEGaS score was 9.14 ± 3.72 (range 3–16). Videos originated from 11 different countries, with India contributing 38.1% (n=8). No significant correlation was found between popularity metrics and educational quality (p>0.05). Conclusion: Laparoscopic radical nephrectomy videos on YouTube demonstrate a moderate level of educational quality. The lack of association between popularity and educational value highlights the necessity of quality assessment tools in surgical education.