Purpose of reviewThis review summarize the proper counseling for men with severe male factor infertility.Recent findingsMen who are experiencing infertility should have a semen analysis, the results of which may imply additional investigations, including genetic and hormonal. Moreover, possible modifiable factors that may harm men's reproductive health should be carefully evaluated. Finally, different treatment options are available.SummaryApproximately 15% of couples struggle with infertility. Complete evaluations of both men and women are required to determine the etiology of infertility and determine appropriate treatment.

Introduction:We sought to better understand the amounts and distribution of political contributions made by urologists in the United States.Methods:The Federal Election Commission was analyzed for political contributions from 2003 to 2022 using the search terms “urology,” “urologist,” or “urologic surgeon.” Contributions were classified by political party (Democratic, Republican, or Independent) and were analyzed for temporal, geographic, and demographic trends.Results:There were a total of 26,441 unique contributions that resulted in $9,943,205 after adjusting for inflation. The total amount of political contributions increased significantly over time, with higher numbers during presidential election years. The Republican party received the highest proportion of donations (69.1%). Importantly, women urologists and urologists working in academic centers were significantly more likely to contribute to Democratic committees (P < .001 for both). Texas had the highest total amount of contributions ($395,152). Overall contributions to urology political action committees have steadily decreased since 2011, while contributions to individual campaigns and nonurology political action committees have increased.Conclusions:Urologists have been increasingly contributing to political campaigns over the past 19 years, with most of their individual and political action committee contributions going to Republican committees and candidates. Future research evaluating how growing political engagement by urologists affects the development of new health care policy will be important as a new generation of urologists begins to enter practice.

The last several years have been marked by personal isolation and division. However, these trying times also have highlighted the connectedness of our global community and the impact of human relationships. There is perhaps no profession so intimately linked to human connection as medicine. This is even more true in the close-knit field of urology. Our lives are constantly shaped by mentors, colleagues, patients, and numerous others.Each year, the AUA Residents and Fellows Committee sponsors an essay contest to engage urology trainees and encourage introspection and creativity. This year's essay prompt, Advancing Urology Together, acknowledged that there are many people who impact and influence our education. The prompt asked trainees to describe a personal relationship in urology that broadened their perspective on the world and enhanced their clinical practice.We received many outstanding responses from medical students, residents, and fellows from the United States and throughout the world. Of these essays, several finalists were selected and can be reviewed in their entirety on the AUA website. These finalists spoke eloquently of the impact of mentors, clinical staff, and even their own selfdoubt on their development as urologists.Ultimately, the committee selected the essay authored by Nicolas Seranio, MD, a fourth-year urology resident at Stanford University, for the grand prize. As you will appreciate, this moving essay is a beautiful tribute to a dearly loved faculty member recently lost from the urological community. The impact of Dr Doug Canning's humility and ability to empower his learners was transformational to the author's education. This posture is instructive to all urologists in their interactions with both learners and patients alike. It is also worth noting that this was not the only essay this year to highlight Dr Canning's profound impact. We are confident that in reading Dr Seranio's words, you will find deeper appreciation of these meaningful relationships in your own life.

Background Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. Methods Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. Results In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 – 1.47), and 1.08, 95%CI 0.89 – 1.30, respectively). This was also true at both shorter (≤ 2 yr) and longer-term (> 2 yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86–1.30). Conclusions We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man’s bladder cancer risk.

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