Objective: The objective of this study is to present a summary of the updated 2025 European Association of Urology (EAU) guidelines on sexual and reproductive health (SRH), focusing on hypogonadism, erectile dysfunction (ED), premature ejaculation (PE), and Peyronie’s disease (PD), providing practical recommendations on the clinical workup, with a focus on diagnosis, treatment, and follow-up.

Evidence acquisition: The panel conducted an updated systematic review of new research published in 2021–2024 in Medline, EMBASE, and Cochrane Libraries. The guidelines’ recommendations focused on key clinical decisions that would impact patient care most. Each recommendation’s strength was evaluated based on three factors: the trade-offs between benefits and drawbacks of different treatment approaches, the quality and reliability of the available evidence, and the diverse preferences and values of patients.

Key findings: Along with a detailed basic and advanced diagnostic approach for every condition, key recommendations emphasise the importance of appropriate indications and subsequent follow-up for testosterone therapy in patients with late-onset hypogonadism (LOH), a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/ or action. The decision-making algorithm for treating ED—defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance—aims to support personalised treatment tailored to individual patients, according to the invasiveness, tolerability, and effectiveness of the different therapeutic options and patients’ expectations. Hence, patients should be fully counselled with respect to all available treatment modalities. The EAU guidelines adopted the definition of PE, which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient’s expectations should be discussed thoroughly, and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. An accurate baseline assessment of patients with PD should differentiate between acute and stable phases of the disorder. Surgical treatment for PD should be offered to patients having a penile deformity with a negative impact on sexual function: patients with concomitant ED should be offered penile prosthesis implantation.

Conclusions and clinical implications: This overview of the 2025 EAU SRH guidelines offers valuable insights into the diagnosis, treatment, and follow-up of LOH, ED, PE, and PD.

目的：本研究旨在总结2025年欧洲泌尿外科协会（EAU）性与生殖健康（SRH）指南的更新内容，重点关注性腺功能减退症、勃起功能障碍（ED）、早泄（PE）及佩罗尼病（PD），并就临床检查（侧重于诊断、治疗和随访）提供实用建议。

证据获取：专家组对2021–2024年发表在Medline、EMBASE和Cochrane图书馆的新研究进行了更新的系统综述。指南建议聚焦于对患者护理影响最大的关键临床决策。每项建议的强度基于三个因素评估：不同治疗方案的利弊权衡、现有证据的质量和可靠性，以及患者的多样化偏好与价值观。

主要发现：除了针对每种疾病的详细基础及进阶诊断方法外，核心建议强调：对于迟发性性腺功能减退症（LOH，一种老年男性临床状态，表现为循环睾酮水平降低，且伴随与激素生成和/或作用受损相关的特定症状）患者，睾酮治疗的适当适应症及后续随访至关重要。

勃起功能障碍（定义为持续无法获得和维持足以完成满意性行为的勃起）的治疗决策算法，旨在根据不同治疗方案的侵入性、耐受性、有效性及患者期望，为个体患者提供个性化治疗。因此，应向患者充分告知所有可用的治疗方式。

EAU指南采用国际性医学学会制定的早泄定义。在明确早泄亚型后，需深入讨论患者期望：对于终身性早泄患者，药物治疗应作为一线方案；而对于获得性早泄患者，初始目标应为治疗其潜在病因。

对佩罗尼病患者的准确基线评估应区分该病的急性期与稳定期。佩罗尼病的手术治疗应提供给阴茎畸形已影响性功能的患者；对于合并勃起功能障碍的患者，应考虑阴茎假体植入术。 

结论与临床意义：本综述概述了2025年EAU性与生殖健康指南，为迟发性性腺功能减退症、勃起功能障碍、早泄及佩罗尼病的诊断、治疗和随访提供了有价值的参考。