Publications by authors named "Hussein Ghanem"

23 Publications

  • Page 1 of 1

Intra-Cavernous Injection of BOTOX (50 and 100 Units) For Treatment of Vasculogenic Erectile Dysfunction: Randomized Controlled Trial.

Andrology 2021 Mar 30. Epub 2021 Mar 30.

Department of urology, Banha University Hospital, Egypt.

Background: Erectile dysfunction (ED) is a socio-economic problem, there are several options for its management including Intra-Cavernosal Injection (ICI).

Objective: To compare the safety, efficacy, and durability of ICI of Onabotulinum toxin-A (BTX)in different doses (50 & 100 U) against placebo (saline) in the Management of Vasculogenic ED non-responding to pharmacological therapy (phosphodiesterase type 5 inhibitors or/and ICI of trimix).

Materials And Methods: A prospective randomized double-blind placebo-controlled trial conducted between July 2016 to February 2019. A total of 176 patients were randomly assigned (1:1:1) to one of the treatment sequences: Botox 100 U group (BTX-100; 62 patients), Botox 50 U group (BTX-50; 59 patients) or Placebo group (55 patients). All patients were followed-up for 6 months.

Results: Significant improvement in all parameters i.e.; SHIM score & Erection Hardness Score (EHS), Sexual Encounter Profile (SEP), Global Assessment Score (GAS) and Doppler parameters (P < 0.001) was observed in patients of BTX-100 and BTX-50 groups with maximum improvement at 3 month of treatment. Around 40% of patients were responders and abled to engage in sexual intercourse. Patients in placebo group didn't experience significant improvement (P = 0.264). It was noted that; at the 2 week and 3 months after treatment, there was no statistically significant difference in the improvement of these parameters in BTX-100 & BTX-50 groups (P >0.05). In the 6 month, there was a statistically significant difference between the aforementioned groups in favor of BTX-100 (P< 0.01).

Conclusions: only one-time ICI of BTX (50 U and 100 U) is effective and safe for the treatment of refractory ED. This agent has a considerable long duration of action particularly BTX-100U seems to be more durable.
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http://dx.doi.org/10.1111/andr.13010DOI Listing
March 2021

Analysis of Pathogenicity and Virulence Factors of .

Front Plant Sci 2020 17;11:527787. Epub 2020 Sep 17.

Chongqing Key Laboratory of Plant Disease Biology, College of Plant Protection, Southwest University, Chongqing, China.

(ALCScV) is a novel monopartite begomovirus, which was identified from plants in Sichuan Province, China. In this study, we showed that ALCScV can induce typical dwarf and downward leaf-curling symptoms in , , and plants and that the noncognate betasatellite can enhance disease symptoms and increase viral accumulation. Expression of the ALCScV-encoded V2, C1, and C4 proteins through a (PVX) vector caused severe symptoms in . Further study revealed no symptoms in plants inoculated with infectious ALCScV clones lacking the C4 protein and that the relative viral DNA accumulation levels significantly decreased when compared with ALCScV-inoculated plants. Thus, our mutational analyses demonstrated that C4 is a pathogenicity determinant that plays key roles in symptom formation and virus accumulation. Furthermore, we also demonstrated that the second glycine of C4 was critical for ALCScV pathogenicity.
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http://dx.doi.org/10.3389/fpls.2020.527787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527423PMC
September 2020

Suppression of nbe-miR1919c-5p Expression in Enhances Tobacco Curly Shoot Virus and Its Betasatellite Co-Infection.

Viruses 2020 04 1;12(4). Epub 2020 Apr 1.

Chongqing Key Laboratory of Plant Disease Biology, College of Plant Protection, Southwest University, Chongqing 400716, China.

MicroRNAs (miRNAs) are non-coding but functional RNA molecules of 21-25 nucleotides in length. MiRNAs play significant regulatory roles in diverse plant biological processes. In order to decipher the relationship between nbe-miR1919c-5p and the accumulations of tobacco curly shoot virus (TbCSV) and its betasatellite (TbCSB) DNAs, as well as viral symptom development, we investigated the function of nbe-miR1919c-5p during TbCSV and TbCSB co-infection in plants using a PVX-and a TRV-based short tandem target mimic (STTM) technology. Suppression of nbe-miR1919c-5p expression using these two technologies enhanced TbCSV and TbCSB co-infection-induced leaf curling symptoms in plants. Furthermore, suppression of nbe-miR1919c-5p expression enhanced TbCSV and TbCSB DNA accumulations in the infected plants. Our results can advance our knowledge on the nbe-miR1919c-5p function during TbCSV and TbCSB co-infection.
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http://dx.doi.org/10.3390/v12040392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232422PMC
April 2020

Tobacco curly shoot virus C3 protein enhances viral replication and gene expression in Nicotiana benthamiana plants.

Virus Res 2020 05 18;281:197939. Epub 2020 Mar 18.

Chongqing Key Laboratory of Plant Disease Biology, College of Plant Protection, Southwest University, Chongqing, 400716, China. Electronic address:

Geminiviruses are single-stranded DNA viruses that cause devastating diseases in many crops worldwide. The replication enhancer proteins (REn), encoded by the C3 (AC3, and AL3) ORFs of geminiviruses, have critical roles in viral DNA accumulation and symptom development in infected plants. In the current study, we have constructed an infectious clone of the Tobacco curly shoot virus (TbCSV) C3 mutant, TbCSV, that contains two start codon mutations that abrogated C3 ORF expression, but did not alter the amino acid sequence of the C2 ORF. As predicted, the absence of the C3 protein reduced TbCSV DNA accumulation, and over-expression of the C3 protein enhanced TbCSV DNA accumulation in infected leaves of Nicotiana benthamiana. The C3 mutation reduced the expression levels of both virion- and complementary-sense TbCSV genes whereas over-expression of the C3 protein increased TbCSV gene expression. Furthermore, the expression of the wild-type and site-directed mutants of C3 proteins using the potato virus X (PVX) system showed that Y93A mutation reduced the replication enhancement activity of the C3 protein in N. benthamiana. All the available evidence demonstrates that the C3 protein is tightly coupled with TbCSV DNA accumulation. However, the TbCSV mutant was nearly as infectious in N. benthamiana as TbCSV and only had slightly delayed and attenuated symptom expression. Our findings demonstrate that TbCSV C3 protein enhances viral replication and gene expression, but has only moderate effects on symptom development in N. benthamiana.
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http://dx.doi.org/10.1016/j.virusres.2020.197939DOI Listing
May 2020

Botulinum Neurotoxin and Its Potential Role in the Treatment of Erectile Dysfunction.

Sex Med Rev 2018 01 23;6(1):135-142. Epub 2017 Aug 23.

Andrology Department, Cairo University Hospitals, Cairo, Egypt.

Introduction: Botulinum toxin type A (BoNT-A) has been used to treat several striated and smooth muscle disorders. During the past year, human and animal studies conducted in Egypt and Canada by two different groups of investigators have suggested a possible role for the intracavernosal injection of BoNT-A in the treatment of erectile dysfunction (ED).

Aim: To discuss BoNT-A and its current medical uses, the rationale for its new potential use in the treatment of ED, and the available evidence and concerns.

Methods: A literature search was conducted. This review was based on the available studies presented at the European Society for Sexual Medicine, Sexual Medicine Society of North America, and International Society for Sexual Medicine meetings in 2016 by the two groups.

Main Outcome Measures: Sinusoidal diameter; penile color Doppler study; Erection Hardness Score; Sexual Health Inventory for Men questionnaire; and Sexual Encounter Profile questions 2 and 3.

Results: Two human studies conducted by the authors and two animal studies (one from the authors' group and one from Canada) were reviewed. These seemed to suggest generally favorable outcomes with the use of BoNT-A in the treatment of ED.

Conclusion: BoNT-A could be a potential therapy for ED. In addition to the findings of the three pilot studies, larger multicenter trials need to be conducted to further explore the true therapeutic efficacy and clinical safety of BoNT-A in the treatment of ED. Ghanem H, Raheem AA, AbdelRahman IFS, et al. Botulinum Neurotoxin and Its Potential Role in the Treatment of Erectile Dysfunction. Sex Med Rev 2018;6:135-142.
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http://dx.doi.org/10.1016/j.sxmr.2017.07.008DOI Listing
January 2018

Re: Botox for Erectile Dysfunction.

Authors:
Hussein M Ghanem

J Sex Med 2017 06;14(6):865

Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address:

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http://dx.doi.org/10.1016/j.jsxm.2017.04.662DOI Listing
June 2017

Infrapubic Liposuction for Penile Length Augmentation in Patients with Infrapubic Adiposities.

Aesthetic Plast Surg 2017 Apr 2;41(2):441-447. Epub 2017 Feb 2.

Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, 8th Labib Elbatanoni, Elmanyal, Cairo, Egypt.

Introduction: Hidden penis, inconspicuous and concealed penis are synonyms for the same entity "buried penis" where the penile shaft is hidden below the surface of the prepubic fat to an extent that gives an impression of a short penis, despite corporeal length being normal.

Aim: The aim of our work is the reduction in the amount of the suprapubic fat by liposuction to reveal the buried penis and assess the results, patient satisfaction and possible complications.

Methods: The procedure of suprapubic liposuction was carried out on ten men who were attending the outpatient clinic of Andrology complaining of small-sized penis.

Main Outcome Measures: Pre-, immediate (on table) postoperative and 3 months postoperative skin to tip flaccid and stretched penile lengths were measured. Patient satisfaction was assessed using the five-point Likert scale.

Results: There was a statistically significant increase between the pre- and postoperative flaccid and stretched penile lengths in our patients with a p value <0.001 in both.

Conclusion: An acquired adult buried penis is a correctable problem. Simple buried penis due to excess fat at the mons pubis should be differentiated from other complex cases that may require combined techniques to achieve good results with minor complications. Suprapubic liposuction is a very safe and successful procedure with minor or no complications if performed meticulously. It could improve self-esteem along with the associated physical and esthetic concerns.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-017-0786-2DOI Listing
April 2017

SOP conservative (medical and mechanical) treatment of erectile dysfunction.

J Sex Med 2013 Jan;10(1):130-71

Private Urological/Andrological Practice, Hamburg, Germany.

Introduction: Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships.

Aim: The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures.

Methods: The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included.

Results: Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3-5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation.
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http://dx.doi.org/10.1111/jsm.12023DOI Listing
January 2013

Erectile dysfunction.

Lancet 2013 Jan 5;381(9861):153-65. Epub 2012 Oct 5.

Department of Urology, University of Ottawa, Ottawa, ON, Canada.

Erectile dysfunction is a common clinical entity that affects mainly men older than 40 years. In addition to the classical causes of erectile dysfunction, such as diabetes mellitus and hypertension, several common lifestyle factors, such as obesity, limited or an absence of physical exercise, and lower urinary tract symptoms, have been linked to the development of erectile dysfunction. Substantial steps have been taken in the study of the association between erectile dysfunction and cardiovascular disease. Erectile dysfunction is a strong predictor for coronary artery disease, and cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended. Substantial advances have occurred in the understanding of the pathophysiology of erectile dysfunction that ultimately led to the development of successful oral therapies, namely the phosphodiesterase type 5 inhibitors. However, oral phosphodiesterase type 5 inhibitors have limitations, and present research is thus investigating cutting-edge therapeutic strategies including gene and cell-based technologies with the aim of discovering a cure for erectile dysfunction.
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http://dx.doi.org/10.1016/S0140-6736(12)60520-0DOI Listing
January 2013

SOP: corpus cavernosum assessment (cavernosography/cavernosometry).

J Sex Med 2013 Jan 12;10(1):111-4. Epub 2012 Sep 12.

Instituto H. Ellis, São Paulo, Brazil.

Introduction: There is no universal gold standard diagnostic test to differentiate psychogenic from organic erectile dysfunction (ED). Cavernosography/cavernosometry has been used to evaluate veno-occlusive dysfunction (VOD) in men with a proposed organic ED.

Aim: To develop evidence-based guidelines for the performance and interpretation of cavernosography/cavernosometry.

Methods: Review the methodology behind cavernosography/cavernosometry and evaluate the evidence that supports its use and interpretation of results.

Main Outcome Measure: Expert opinion based on review of the literature, extensive internal committee discussion, public presentation, and debate.

Results: The detailed technique of cavernosography/cavernosometry is described. An evidence-based perspective to the use and interpretation of cavernosometry is presented.

Conclusion: The positive predictive value of cavernosometry still needs further assessment. It is unknown how many potent men would test positive for VOD (false positive).
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http://dx.doi.org/10.1111/j.1743-6109.2012.02795.xDOI Listing
January 2013

SOP: physical examination and laboratory testing for men with erectile dysfunction.

J Sex Med 2013 Jan 23;10(1):108-10. Epub 2012 Apr 23.

Department of Andrology, Sexology & STDs, Cairo University, Faculty of Medicine, Cairo, Egypt.

Introduction: Physical examination and laboratory evaluation of men with erectile dysfunction (ED) are opportunities to identify potentially life-threatening etiologies and comorbid conditions.

Aim: To review genital anatomy, identify any physical abnormalities, assess for comorbid conditions, and reveal significant risk factors for ED.

Methods: Expert opinion was based on evidence-based medical literature and consensus discussions between members of this International Society for Sexual Medicine (ISSM) standards committee.

Results: For men with ED, a general examination including blood pressure and pulse measurements and a focused genital exam are advised. Fasting blood sugar, serum total testosterone, prolactin levels, and a lipid profile may reveal significant comorbid conditions.

Conclusions: Though physical examination and laboratory evaluation of most men with ED may not reveal the exact diagnosis, these opportunities to identify critical comorbid conditions should not be missed.
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http://dx.doi.org/10.1111/j.1743-6109.2012.02734.xDOI Listing
January 2013

Position paper: Management of men complaining of a small penis despite an actually normal size.

J Sex Med 2013 Jan 18;10(1):294-303. Epub 2012 Apr 18.

Department of Andrology, Sexology & STDs, Cairo University, Faculty of Medicine, Cairo, Egypt.

Introduction: With the worldwide increase in penile augmentation procedures and claims of devices designed to elongate the penis, it becomes crucial to study the scientific basis of such procedures or devices, as well as the management of a complaint of a small penis in men with a normal penile size.

Aim: The aim of this work is to study the scientific basis of opting to penile augmentation procedures and to develop guidelines based on the best available evidence for the management of men complaining of a small penis despite an actually normal size.

Methods: We reviewed the literature and evaluated the evidence about what the normal penile size is, what patients complaining of a small penis usually suffer from, benefits vs. complications of surgery, penile stretching or traction devices, and outcome with patient education and counseling. Repeated presentation and detailed discussions within the Standard Committee of the International Society for Sexual Medicine were performed.

Main Outcome Measure: Recommendations are based on the evaluation of evidence-based medical literature, widespread standards committee discussion, public presentation, and debate.

Results: We propose a practical approach for evaluating and counseling patients complaining of a small-sized penis.

Conclusions: Based on the current status of science, penile lengthening procedure surgery is still considered experimental and should only be limited to special circumstances within research or university institutions with supervising ethics committees.
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http://dx.doi.org/10.1111/j.1743-6109.2012.02725.xDOI Listing
January 2013

Priapism: pathogenesis, epidemiology, and management.

J Sex Med 2010 Jan;7(1 Pt 2):476-500

Department of Urology, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA.

Introduction: Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics.

Aims: To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management.

Methods: Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes.

Main Outcome Measures: Consensus recommendations were based on evidence-based literature, best medical practices, and bench research.

Results: Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review.

Conclusions: Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance.
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http://dx.doi.org/10.1111/j.1743-6109.2009.01625.xDOI Listing
January 2010

Comparing penile measurements in normal and erectile dysfunction subjects.

J Sex Med 2009 Aug 5;6(8):2305-10. Epub 2009 May 5.

Cairo University, Department of Andrology, Sexology, and STDs, Faculty of Medicine, Cairo, Egypt.

Introduction: With the increase in penile augmentation procedures it becomes important to assess what is the normal erect penile size in both potent men and men with erectile dysfunction (ED).

Aim: The aim of this work is to define the average stretched penile size in normal men and ED patients.

Main Outcome Measures: Penile length and girth.

Methods: This study included 1,027 adult men presenting to a university hospital outpatient clinic. Two groups of patients were included in this research work. Group I comprises normal adult men (949) and Group II, ED patients (78). There were no differences of race, age, height, and weight. Penile length and girth were measured using a tape measure and rigid ruler in the fully stretched states in both groups. All penile measurements were performed by the same physician.

Results: In normal men (Group I) the mean of the fully stretched length was 12.9 +/- 1.9 cm and the mean of the fully stretched girth was 8.9 +/- 0.9 cm. In ED patients (Group II), the mean of the fully stretched length was 11.2 +/- 1.5 cm and the mean of fully stretched girth was 8.8 +/- 0.8 cm. Comparing the mean of fully stretched penile lengths in both groups revealed statistical significant difference (P < 0.001) between them, whereas comparing the mean of fully stretched penile girths in both groups revealed statistical nonsignificant difference (P = 0.474) between them. There were significant positive correlations between fully stretched penile lengths and fully stretched penile girths in both groups.

Conclusion: The average of fully stretched penile length in normal potent men is 12.9 cm, whereas the patients with ED tend to have significantly shorter penises (11.2 +/- 1.5 cm).
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http://dx.doi.org/10.1111/j.1743-6109.2009.01305.xDOI Listing
August 2009

An evidence-based perspective to the medical treatment of male infertility: a short review.

Urol Int 2009 19;82(2):125-9. Epub 2009 Mar 19.

Andrology and Sexology Department, Cairo University, Cairo, Egypt.

Introduction: Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient preferences and values.

Aim: This narrative review aims to assist the physicians to make informed decisions based on the best available evidence in the area of male infertility and the patients' own preferences and values.

Methods: In this review we present the current state of knowledge and uncertainties about the medical management of male infertility. We describe the best available evidence from systematic reviews, randomized controlled studies and observational studies where appropriate.

Results: Data from the literature suggest that gonadotropin treatment of male infertility can lead to a significant increase in pregnancy rates, however larger studies are needed to confirm such findings. Studies including combinations of antiestrogens, antioxidants and androgens are promising but need confirmation with further research.

Conclusions: Most current combination therapies consist of orphan medications without industry support. Andrology research centers and other dedicated departments and units need to conduct randomized controlled trials of sufficient duration, sample number and robust design for groups most likely to benefit from antiestrogens, L-carnitine, antioxidants, and combination therapy. The ease of administration, low cost and mild side effects of antiestrogens justify their utility despite insufficient evidence of effect as monotherapies. Randomized controlled trials assessing other forms of medical therapy and combination therapy are available but are still in the preliminary stages.
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http://dx.doi.org/10.1159/000200785DOI Listing
April 2009

Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial.

Fertil Steril 2010 May 6;93(7):2232-5. Epub 2009 Mar 6.

Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To assess the effect of treatment with a combination of clomiphene citrate as an antiestrogen and vitamin E as an antioxidant on the incidence of pregnancy and sperm variables in men with idiopathic oligozoospermia and infertility.

Design: Prospective, randomized, placebo-controlled trial.

Setting: The outpatient andrology clinic at a university hospital.

Patient(s): Sixty infertile men with idiopathic oligoasthenozoospermia.

Intervention(s): Patients were randomly assigned to two treatment groups: a group receiving the combination of clomiphene citrate (25 mg/day) and vitamin E (400 mg/day; n = 30) against a placebo group (n = 30). Treatment was maintained for 6 months.

Main Outcome Measure(s): Pregnancy incidence and variations in semen parameters.

Result(s): A significantly higher pregnancy rate was found among the combination treatment group in comparison to the control group. The odds ratio was 3.76 and the 95% confidence interval was 1.03-13.64, with a 36.7% pregnancy rate (11/30) in the combination treatment group compared with 13.3% pregnancy rate (4/30) in the control group. The trial showed a significantly higher increase in sperm count and progressive sperm motility with nonsignificant changes in total sperm motility, percentage of abnormal forms and semen volume in the combination treatment group as compared to the control group.

Conclusion(s): The combination of clomiphene citrate as an antiestrogen and vitamin E as an antioxidant can significantly increase the pregnancy rate and improve sperm count and progressive sperm motility in cases of idiopathic oligoasthenozoospermia.
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http://dx.doi.org/10.1016/j.fertnstert.2009.01.117DOI Listing
May 2010

Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence by GS Brindley.

J Sex Med 2008 Aug;5(8):1791-4

Department of Urology, Instituto H. Ellis, São Paulo, Brazil.

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http://dx.doi.org/10.1111/j.1743-6109.2008.00954.xDOI Listing
August 2008

Alternate-day tadalafil in the management of honeymoon impotence.

J Sex Med 2008 Jun 18;5(6):1451-4. Epub 2008 Jan 18.

Cairo University-Andrology, Sexology & STDs, Cairo, Egypt.

Introduction: Sildenafil has been used successfully in the treatment of honeymoon impotence. However, no study investigated the potential effect of tadalafil in the treatment of honeymoon impotence.

Aim: The aim of this study is to evaluate the effectiveness of alternate-day tadalafil therapy in the management of unconsummated marriages.

Methods: This is a descriptive study comprised of a series of 45 patients. The time frame for the study was 2 years. Forty-five consecutive patients underwent a complete medical and sexual history as well as a focused physical examination. Education about the male and female genital anatomy and the sexual response cycle was carried out. Alternate-day tadalafil 10-mg therapy was administered for 2 weeks with the duration extended as needed.

Main Outcome Measures: Primary efficacy endpoints were successful vaginal intromission and change in the abridged version of the International Index of Erectile Function (IIEF-5).

Results: Of 45 patients included in our study, 41 (91%) were able to achieve vaginal intromission and perform sexually. Thirty-four patients (76%) needed tadalafil for less than 1 month, five (11%) for up to 3 months, and two (4%) for more than 3 months. Four patients (9%) were unsuccessful. IIEF-5 improved significantly with alternate-day tadalafil treatment in this subgroup of patients (P < 0.001). Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause.

Conclusions: Tadalafil therapy was safe and effective in the short-term management of this selected group of honeymoon impotence patients. Controlled studies are needed to further confirm these findings.
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http://dx.doi.org/10.1111/j.1743-6109.2007.00748.xDOI Listing
June 2008

An evidence-based perspective to commonly performed erectile dysfunction investigations.

J Sex Med 2008 Jul;5(7):1582-9

Cairo University-Andrology, Sexology & STDs, Cairo, Egypt.

Introduction: Currently there is no universally accepted gold standard diagnostic test to differentiate psychogenic from physical erectile dysfunction (ED). Instead, sexual health specialists rely on a detailed history, a focused physical examination, and specialized diagnostic tests, to decide if the etiology of the ED is mainly psychogenic or organically caused. Aim. In this review we point out the status of evidence-based principles in the area of diagnosis in Sexual Medicine.

Methods: We review the concepts of evidence-based medicine (EBM) in the area of medical diagnostic tests. We highlight four of the well-known diagnostic tests (penile duplex, pharmacoarteriography, pharmacocavernosometry/cavernosography [PHCAS/PHCAG], and nocturnal penile tumescence [NPT monitoring]) for ED evaluation within an evidence-based perspective.

Main Outcome Measures: Assessment of diagnostic tests for ED using principles of EBM.

Results: Several good diagnostic tests are useful in the evaluation of men with ED. However, modern evidence-based concepts-mainly the likelihood ratio-have not yet been applied to these tests to obtain their maximum clinical benefits.

Conclusions: While penile duplex/color Doppler has good evidence of supporting its use in the diagnosis of arteriogenic ED, data supporting its diagnosis of a physical disorder associated with cavernous venous occlusion dysfunction are lacking. PHCAS/PHCAG's main drawback is an unknown positive predictive value and a possibility of frequent false-positive results. NPT has many advantages when differentiating psychogenic from organic ED, however, several questions related to its physiological mechanisms do exist. Ghanem H, and Shamloul R. An evidence-based perspective to commonly performed erectile dysfunction investigations.
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http://dx.doi.org/10.1111/j.1743-6109.2007.00665.xDOI Listing
July 2008

Experience with Tube (Promedon) malleable penile implant.

Urol Int 2007 ;79(3):244-7

Andrology and Sexology Department, Cairo University Hospital, Beni-Sueif, Egypt.

Introduction: The main advantages of semirigid penile prosthesis are simple implantation, ease of use, very low risk of mechanical failure and more financial suitability for patients in developing countries.

Aim: To evaluate reliability and safety of Tube(R) (Promedon, Cordoba, Argentina) penile prosthesis in the surgical treatment of erectile dysfunction.

Patients And Methods: This retrospective case series was conducted on 83 patients who underwent Tube penile implant surgeries between 2001 and 2006. The choice of Promedon penile implant was determined by the patient himself. Strict infection control measures were applied. Patients were followed up for stability of vital signs and discharged within 72 h.

Results: Successful sexual intercourse was possible for 75 (90.4%) of cases. Common postoperative complaintswere: prosthesis too short in 27 cases (32.5%), not happy with the appearance of the penis in 8 cases (9.6%), non-specific pain which subsided spontaneously in 20 cases (24%), in which no further intervention was done apart from reassurance. 79 (95.2%) patients were on regular follow-up for the first year and the rest dropped out. None of the patients experienced prosthetic infection postoperatively. Crural cross-perforation (4%) was managed intraoperatively. Hematomas (1.6%) were managed conservatively. Retarded ejaculation (10%) and penile hypothesia (0.8%) resolved spontaneously within 6 months in all cases.

Conclusion: The Promedon malleable penile prosthesis is reliable and safe in the surgical treatment of erectile dysfunction.
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http://dx.doi.org/10.1159/000107957DOI Listing
November 2007

Structured management and counseling for patients with a complaint of a small penis.

J Sex Med 2007 Sep 6;4(5):1322-7. Epub 2007 Apr 6.

Cairo University-Andrology, Cairo, Egypt.

Introduction: Penile augmentation surgery has become increasingly common though there is no consensus about the management strategy for men with a complaint of small penis.

Aim: To introduce and evaluate the outcome of a structured management and counseling protocol for patients with a complaint of a small-sized penis.

Methods: A structured protocol for consultation and management of (physically normal) patients with a complaint of a small penis through a descriptive study comprised of a series of 250 patients.

Main Outcome Measures: Percentage of patients who elect to undergo penile augmentation surgery.

Results: Only nine patients (3.6%) chose to seek further surgical intervention. Two had a buried penis, two had true micropenis and five had normal penile size.

Conclusions: Using a structured management and counseling protocol, most men chose not to undergo penile augmentation surgery, even when offered for free.
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http://dx.doi.org/10.1111/j.1743-6109.2007.00463.xDOI Listing
September 2007

Intracavernous chlorpromazine versus phentolamine: a double-blind clinical comparative study.

J Sex Med 2004 Nov;1(3):310-3

Department of Andrology, Sexology and STDs, Cairo University, Cairo, Egypt.

Introduction: Intracavernous pharmacotherapy is one of the most common treatment modalities of erectile dysfunction (ED). There are different drugs that are used for intracavernous injection including papaverine, phentolamine, prostaglandins E1, phenoxybenzamine, and moxisylate.

Aim: The aim of this study is to evaluate the efficacy of chlorpromazine as an intracavernous vasoactive agent alone or with other drugs.

Methods: This study was performed on 50 patients presenting to our department complaining of ED. Patients were divided into three groups according to the type of intracavernous drug injected. Group A included 20 patients who received an intracavernous injection of 1 mL bimix (30 mg papaverine + 1 mg phentolamine) followed a week later by intracavernous test dose using a 1 mL mixture of papaverine and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine). Group B included 20 patients who received an intracavernous injection of 1 mL trimix (30 mg papaverine + 1 mg phentolamine + 10 microg PGE1). A week later they received another intracavernous test dose using a 1 mL mixture of papaverine, PGE1, and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine + 10 microg PGE1). Group C included 10 patients who received various intracavernous injections of chlorpromazine in doses 1 mg, 2 mg, 5 mg, and 10 mg.

Results: There was no significant difference in erection response and erection duration between phentolamine and chlorpromazine. Prolonged erection occurred in two patients of group B and postural hypotension occurred in three patients of group C.

Conclusion: Chlorpromazine can be used as an intracavernous vasoactive agent; it is similar to phentolamine in efficacy and short-term side effect profile.
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http://dx.doi.org/10.1111/j.1743-6109.04044.xDOI Listing
November 2004

Testosterone therapy can enhance erectile function response to sildenafil in patients with PADAM: a pilot study.

J Sex Med 2005 Jul;2(4):559-64

Department of Andrology, Sexology and STDs, Cairo University, Cairo, Egypt.

Introduction: Recent studies suggest a direct relationship between free testosterone and cavernous vasodilatation. Some men with erectile dysfunction (ED) associated with PADAM (partial androgen deficiency in aging men) might possibly benefit from testosterone undecanoate therapy (TRT).

Objectives: To determine the efficacy of testosterone undecanoate in facilitating the erectile response and patient satisfaction with sildenafil in men 40-70 years old with PADAM symptoms.

Design And Methods: Prospective study including 40 patients recruited after a sildenafil therapeutic trial. Total testosterone and sex hormone binding globulin (SHBG) were measured to calculate the free androgen index. Prostate specific antigen (PSA) was measured and repeated 2 months after treatment. A rating score was used for PADAM symptoms, and the 5-point abbreviated version of the International Index of Erectile Function (IIEF-5) to assess erectile function. Men failing to respond to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT (group 1ST), and TRT (group 1T) alone. Men partially responding to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT for 2 months (group 2ST), or sildenafil alone (group 2S). Treatment efficacy was assessed by analysis of between-group differences.

Results: Groups 1T, 2S, and 2ST showed significant improvement in PADAM scores (P<0.05, Wilcoxon matched pairs test). Patients receiving both sildenafil plus continuous TRT (groups 1ST and 2ST) showed significant improvement in IIEF-5 scores (P<0.5, paired t-test). No significant changes in serum levels of PSA were detected (paired t-test).

Conclusions: We conclude that TRT appears to be beneficial and safe in facilitating the erectile response and patient satisfaction with sildenafil in men with PADAM symptoms. Androgen supplementation should be carried out cautiously with careful monitoring to avoid possible adverse effects.
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http://dx.doi.org/10.1111/j.1743-6109.2005.00071.xDOI Listing
July 2005