Clinical Advances in Male Infertility 1. The Role of Testicular Puncture Cytology and DNA Imaging in the Evaluation of Male Infertility Patients Testicular puncture biopsy is a method of studying male infertility. In this article, Hashem et al. from Egypt explored whether fine needle aspiration biopsies for cytology with DNA analysis can replace open surgical biopsies in the field of male infertility research. The study found that needle cytology was highly similar to open surgical biopsy in the diagnosis of male infertility. In addition, needle biopsy can quantify the percentage of different cell subtypes in the seminiferous tubules by picking out interstitial cells, supporting cells, mature spermatozoa, and distinguishing between spermatogonia and spermatocytes based on the static image, and DNA image analysis can classify cells as haploid, diploid, or tetraploid cells. By combining cytology with DNA image analysis, male doctors can make a comprehensive assessment of the spermatogenesis of the patient. Hashem et al. concluded that needle cytology is accurate, reproducible, simple and easy to perform, and is able to replace open surgery for biopsy. The incidence of varicocele in young men is very high, especially in infertile men with reduced fertility. Surgical treatment of varicocele is expected to improve male fertility. The indications for surgical treatment of varicocele to improve fertility are currently controversial. Male surgeons often need to improve fertility in patients with varicocele aged 35-40 years, but is surgery still beneficial in older patients? This is not clear. In this article, Ollandini of Italy analyzed the improvement in sperm quality after surgical treatment in patients of different ages. It was found that the effect of surgical treatment was independent of age-induced sperm quality, that is to say, the effect of surgical treatment to improve spermatogenesis was not related to age, and for older patients with varicocele, receiving surgical treatment is still beneficial. 3. Comparison of the efficacy of single-port laparoscopy and conventional laparoscopy in the treatment of varicocele Laparoscopic varicocelectomy is safe, effective, and has a low recurrence rate. Xue et al. from China discussed the efficacy of single-port laparoscopic varicocelectomy compared with traditional laparoscopic varicocelectomy in their article. There was no difference between the two in terms of operation time, postoperative complications, postoperative hospitalization days and improvement of sperm quality, but single-port laparoscopy can significantly reduce postoperative pain, and its surgical incision is more beautiful. 4, Exploring the diagnostic criteria of varicocele In clinical practice, there has been a lack of a set of objective criteria for the diagnosis and treatment of varicocele. Wang et al. from China reported the correlation between the maximum diameter of the spermatic vein obtained by ultrasound measurement and the grading of the spermatic vein. They categorized the diameters of the internal spermatic veins into three grades (small veins: less than 2 mm; medium veins: greater than 2 mm, but less than 4 mm; large veins: greater than 4 mm). It was found that there was a significant difference between the number of large vessels in the internal spermatic veins between the 3 grades of varicocele. However, only grade 3 varicocele could be diagnosed on the basis of ultrasound data: a vessel cross-section greater than 2.45 mm at rest or greater than 3.15 mm during the Valsalva maneuver, and at least one large vessel could be detected at the level of the pubic bone in patients with grade 3. Gudeloglu et al. explored the clinical value of robot-assisted second-stage vasectomy recanalization. The success rate of second-stage vasectomy remains low in patients who have undergone 1 microscopic vasectomy and have failed the procedure.Gudeloglu et al. analyzed cases of robotic-assisted surgery (RAVV) versus microsurgery (RAVE) and evaluated semen quality of the patients at 2, 5, 9, and 12 months, and also compared preoperative and postoperative pain scores. The apparent efficiency of RAVE (greater than or equal to 1 million motile spermatozoa after each ejaculation) was found to be 100% in RAVV and 50% in RAVE. The pain problem was resolved in all patients. Accordingly they concluded that RAVV is one of the optional procedures for second-stage vasectomy recanalization. Yamaguchi et al. reported the sperm acquisition rate in 300 patients with nonobstructive azoospermia (NOA) who underwent microtomy testicular sperm extraction (micro-TESE) and some of the clinical indicators affecting the outcome of the procedure. Candidate indicators included testicular size, hormone levels and age. The final results showed that these indicators were not predictors of micro-TESE efficacy. Although there was a significant difference in age between the treatment success and treatment failure groups, this difference was not statistically significant. Sperm were successfully obtained in only 30.5% of all patients, and the rate of sperm acquisition was not the same in patients with various types of NOA; the type with the highest success rate was hypospadias (87.8%), and the lowest was simple support cell syndrome (20.3%). And the most common type of NOA, idiopathic non-obstructive oligozoospermia, had a sperm acquisition rate of 23.5%. Cell phones have become an essential part of everyday life, but their radiation has effects on the heart, brain, endocrine system and DNA.Boulos explored the effects of cell phone use on sperm motility, sperm count, effective sperm and gross morphology. The study found that the longer the daily use of cell phones, the worse the indicators of sperm motility, sperm count, effective spermatozoa, and fewer spermatozoa with normal morphology, and there was a strong correlation between the indicators. Cell phone use has a significant negative impact on sperm quality, so cell phones should be avoided in pockets, used as alarm clocks, and left in the bedroom while sleeping. Trottmann discussed the value of vasovaginal ultrasound in male diagnosis and described the use of vasovaginoscopy in male medicine, e.g., for the treatment of obstructive azoospermia, and for obtaining sperm in patients with erectile dysfunction due to spinal cord injury. Vasovaginoscopy has great clinical applications. Kogan explored the use of antibiotics in patients with concurrent chronic bacterial prostatitis and male infertility, concluding that antibiotics should be used on the basis of individual sensitivities, and that broad-spectrum antibiotics should be used.Gordon et al. reported that the EAU guidelines have largely reduced the necessity of semen testing after vasectomy, with the EAU guidelines suggesting that as long as, at week 12, semen testing shows that the patient Azoospermia, or a relatively low amount of viable spermatozoa, is sufficient to consider the vasectomy procedure to be more effective. Trottmann, on the other hand, reported on a method of in situ detection of viable sperm – the confocal laser microprobe – which is effective in detecting spermatogenic activity in the testis, thus helping to improve the success rate of sperm retrieval.