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Net greenhouse experiment was conducted through the 2019/2020 and 2020/2021 seasons at Dokki protected cultivation experimental site, Central Laboratory for Agricultural Climate (CLAC), Agricultural Research Center (ARC), Ministry of Agriculture and Land Reclamation to investigate applied two factors organic mulch i.e., (bagasse, compost, palm fibers, mushroom spent, sawdust and control), mycorrhizal inoculation (with and without) and their interaction on growth and productivity of tomato plants. The seedlings of tomato cv. Super strain B was transplanted on the 15th October 2019 and 2020. The experimental design was split plot with three replicates. Results indicated that applied compost mulch treatment, without mycorrhizal inoculation and their interaction enhanced all vegetative growth characteristics i.e., (plant height, number of leaves, number of shoots, stem diameter, fresh and dry weights of plant). Whereas, applied compost mulch treatment, with mycorrhizal inoculation and their interaction improved chemical content of (N, P and K) in leaves and increased average fruit weight and total yield/m2.

Background Different treatment options are available for the management of BPH. Our study aimed to compare the surgical outcomes of a holmium laser enucleation of the prostate (HoLEP) and a bipolar transurethral resection of the prostate (Bipolar-TURP) after 2 years. Methods Our prospective randomized study included 114 patients: 55 patients underwent HoLEP procedure and 59 patients underwent bipolar TURP procedure. All patients underwent a complete preoperative assessment and a physical examination. The postoperative follow-up data included Q max and IPSS recordings at 1, 3, 6, 12, and 24 months and PVR urinary volume recordings at 6 and 12 months. Any postoperative complications were also recorded. Results There were no statistically significant differences between both groups regarding IPSS and Q max scores at one and 24 months postoperative. Also, there were no statistically significant differences between both groups regarding postoperative PVR at 6 and 12 months. One patient in the HoLEP group developed total incontinence after surgery. Conclusion Our study did not show a significant difference between HoLEP and bipolar TURP regarding postoperative Q max and IPSS scores at 24 months of follow-up.

Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. Objective: To find the relation of renal parenchymal thickness & isotope scan preoperatively & postoperatively in predicting outcome after pyeloplasty. Patients and Methods: This prospective study included, 30 children ≤ 18 years, with 1ry unilateral UPJO from September 2018 to September 2019 were included in the study. Ultrasound abdomen was done on all patients to look at the size of the kidney, parenchymal thickness & renal echogenicity. DTPA scan was done to measure the GFR, t½ and split function of each kidney & all patients underwent open pyeloplasty. Patients were followed up after the operation at 1, 3, and 6 months respectively. At each follow-up visit, U/S was performed & renal isotope was done at the 6th month. The preoperative parameters were compared with the same parameters after surgical repair of the UPJO at 3rd & 6th months. Results: In our study, there was an improvement in (83.3%) with a significant change in all parameters at 6th months postoperatively (P < 0.01) as T ½ significantly decreased while parenchymal thickness, GFR of the affected kidney & split renal function were significantly increased postoperatively. Conclusions: This study showed that parenchymal thickness and renal isotope are good predictors for pyeloplasty outcome.

Background: Overactive bladder (OAB) syndrome, consisting of urgency, with or without urgency incontinence, often with frequency (voiding more than eight times in a 24- h period) and nocturia (need to wake up one or more times per night for urination), is a highly prevalent disorder with a significant impact on quality of life (QoL). Objective: To evaluate the safety and efficacy of mirabegron 50 mg in comparison to solifenacin 5 mg in the treatment of female patients suffering from overactive bladder symptoms. Patients and Methods: This prospective randomized study was conducted in Zagazig University Hospitals during the period From November 2018 to April 2019. Thirty consecutive female patients aged from 18 to 65 years old were included in this study. Results: Mirabegrone significantly was associated with hypertension only in one case, and Solifenacine significantly was associated with blurred vision, constipation and dry mouth. Comparison between mirabegron and solifenacin group according to day and night frequency, urge and urge incontinence pretreatment showed that there was no significant difference between both groups. Comparison between mirabegron and solifenacin groups according to day and night frequency, urge and urge incontinence after taking mirabegrone or solifenacin showed that mirabegron group was significantly lower as regards day and night frequency also in urgency and urgency incontinence post treatment. Conclusions: Solifenacin and mirabegron were effective in improving over active bladder symptoms. Mirabegron showed greater tolerability with fewer patients discontinuing therapy because of side effects. mirabegron can be considered as the drug with the better balance between efficacy and tolerability in the treatment of OAB.

Background: Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus Varicocele is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. They are found in about 15% of adult males and 20–40% of all infertile men. Objective: To find correlation between shear wave elastography result and semen analysis in cases of varicocele. Methods: This prospective study was carried out on 66 patients with primary infertility and clinically detectable varicocele who admitted to the Urology Department Andrology Unit, Zagazig University hospitals during the period from 15/3/2018 to 15/9/2018. Testicular SWE was done for all patients, computer-assisted semen analysis and duppler scrotal ultrasound. Results: Showed that the most varicose character was bilateral grade III of testicular varicocele with primary complain. The highest SWE was 4.27and the lowest SWE was 1.84. SWE was significantly negative correlated with motility and count. On the other hand, there was a non significant negative correlation between SWE stiffness index and progress motility. Conclusion: Our study showed that Testicular SWE is a good test easily applicable and repeatable imaging method, has the potential to be used in the assessment of male infertility with clinically detectable varicocele.

Objectives: To evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults. Patients and methods: In all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of

Objective: To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL). Patients and methods: Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2 were excluded from the study. The following data were reported: patients’ demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR). Results: In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients’ demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P

Objective: To assess the additive effect of sildenafil citrate to tamsulosin in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in men with or without erectile dysfunction (ED). Patients and methods: In all, 150 men with untreated LUTS/BPH with or without ED were randomised to receive sildenafil 25 mg once daily (OD) or placebo OD (night time) combined with tamsulosin 0.4 mg OD (day time) for 6 months. Changes from pre-treatment scores in International Prostate Symptom Score (IPSS), IPSS-quality of life (QoL) score, maximum urinary flow rate (Qmax), and the five-item version of the International Index of Erectile Function questionnaire (IIEF-5) were assessed at 3 and 6 months. Safety profiles were assessed by physical examination and monitoring clinical adverse events. Results: Group A comprised of men who received tamsulosin and sildenafil (75 men), whilst those in Group B received tamsulosin and placebo (75). The IPSS was significantly improved in Group A compared to Group B, at −29.3% vs −13.7% (P = 0.039) at 3 months and −37% vs −19.6% (P = 0.043) at 6 months after treatment. Qmax significantly improved in both groups compared with before treatment (P

Some agro-industrial byproducts [sugar cane molasses (SM), corncobs waste (CW), sugar cane bagasse (SB), sawdust (SD), sugar beet pulp (SBP) and fruit juice waste (FJW)] were used as substrates for bioethanol production by Clavispora lusitaniae Gr45 and Saccharomyces cerevisiae B1 after 3 days incubation at 30°C in static batch culture. Different treatments of these materials as a sole carbon source were applied with or without nitrogen sources (yeast extract or ammonium sulfate). The highest bioethanol concentration when SM is used (13.05 gl-1) was obtained by Sacch. cerevisiae at the treatments: [yeast fermentation medium (YFM) -glucose + 4 % SM], (yeast extract + 6 % SM) and (10% SM), which represent about 10.6 % increase comparing to YFM medium (control). The addition of acid CW hydrolyzate as the sole carbon source to YFM medium was the best of the CW treatments by Cl. lusitaniae Gr45 which recorded the highest bioethanol concentration, productivity, yield and conversion coefficient being, 13.32 gl-1, 0.18 gl-1h-1, 26.64 % and 26.65 %; respectively. These figures were increased to 15.8 gl-1, 0.22 gl-1h-1, 31.6 % and 35.9 %, respectively, on YFM medium containing acid SB hydrolyzate as the sole carbon source. All acid SD hydrolyzate treatments increased bioethanol production by Cl. lusitaniae Gr45 and decreased it by Sacch. cerevisiae B1. The highest bioethanol production obtained on SD was on SD hydrolyzate containing yeast extract followed by SD hydrolyzate only and SD hydrolyzate containing ammonium sulfate being 16.5, 13.76 and 13.54 gl-1; respectively. Using SBP as sole carbon source added to YFM medium decreased significantly the growth and bioethanol production by both strains. Generally, FJW was the best carbon source in YFM medium which increased bioethanol production to about 68 % and 38 % by Sacch. cerevisiae B1 and Cl. lusitaniae Gr45; respectively using static culture technique.

Objectives To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy, in the management of distal ureteric stones (DUS) in terms of stone clearance rate and stone expulsion time. Patients and methods A prospective randomised study was conducted on 115 patients, aged 21–55 years, who had unilateral DUS of ⩽10 mm. Patients were divided into two groups. Group 1 received silodosin (8 mg) and Group 2 received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by ultrasonography, plain abdominal radiograph of the kidneys, ureters and bladder, and computed tomography (in some cases). Results There was a significantly higher stone clearance rate of 83% in Group 1 vs 57% in Group 2 ( P = 0.007). Group 1 also showed a significant advantage for stone expulsion time and analgesic use. Four patients, two in each group, discontinued the treatment in first few days due to side-effects (orthostatic hypotension). No severe complications were recorded during the treatment period. Retrograde ejaculation was recorded in nine and three patients in Groups 1 and 2, respectively. Conclusion Our data show that silodosin is more effective than tamsulosin in the management of DUS for stone clearance rates and stone expulsion times. A multicentre study on larger scale is needed to confirm the efficacy and safety of silodosin.

Background and study aim: One of the main requirements of biomarkers for detecting CRC is that it must allow detection of the disease at earlier stages. The current study is designed to investigate the role of combined M2-Pyruvate kinase, Calprotectin, and Fecal occult blood test measurements as fecal diagnostic biomarkers for early detection of colorectal cancer. Patients & Methods: Total number of 72 subjects (48 patients and 24 healthy controls) were included in the study. Patients with cancer colon and patients with organic non-malignant colorectal lesions were recruited from Oncology and Gastroenterology Outpatient Clinics and Inpatient Department Menoufia University Hospital. Results: There was a highly significant difference between studied groups regarding age and gender (P> 0.001), cancer colon was higher among old age (mean ± SD is 58.96±6.3) and males (70.8%), There was a highly significant difference between studied groups regarding Hb, CRP and ESR (P >0.001); lowest Hb level was detected in cancer group (8.7±1.7). On the other hands highest CRP and ESR levels were in cancer group (7.29±4.47) and (14.71±6.19) respectively. There was a significant difference between studied groups regarding platelets (P >0.05); lowest platelet number was detected in cancer group (272.4±66.9). There was non-significant difference between studied groups regarding WBCs (P 0.001), There was a highly significant difference between studied groups regarding M2-Pyruvate kinase and Occult Blood (P >0.001), There was highly significant difference between M2-PK in cancer and control groups (p >0.001), There was significant difference between calprotectin in cancer and control groups (p >0.05), There was highly significant difference between occult blood in cancer and control groups (p >0.001), There was highly significant difference between Combined M2-PK and Calprotectin in cancer and control groups (p >0.001), There was highly significant difference between Combined M2-PK and Occult blood in cancer and control groups (p>0.001), There was highly significant difference between Combined M2-PK, Calprotectin and occult blood in cancer and control groups (p >0.001). Conclusion: Our study confirms that, Colorectal Cancer (CRC) increases with age and it is more common in male, CRP and ESR increase in CRC patients, Fecal M2PK, FC and FOBT in stool increase significantly in CRC patients, Sensitivity, specificity and accuracy of screening for CRC are highest in combination of fecal M2PK, occult blood in stool and FC tests.

Objective To investigate whether the immunohistochemical expression of p53, p63 and her2/neu is correlated with the prognosis of tumour recurrence and progression in patients with non-muscle invasive (NMI) bladder cancer. Patients and methods In all, 88 patients diagnosed with NMI transitional cell carcinoma of the bladder in a Urology Department from May 2009 to April 2014 were included in the study. Paraffin-embedded specimens were obtained by transurethral resection of the bladder tumours. Sections on haematoxylin and eosin-stained slides were examined histologically and tumour grade was classified according to the World Health Organisation system (2004) Mostofi classification. The sections were evaluated using p63, p53 and her2/neu immunohistochemical staining before and after immunotherapy with bacille Calmette–Guerin (BCG), and patients were followed up for 36 months in the Urology Department. Results For tumour grade there was a significant relationship with the overexpression of p53 (P = 0.010), her2 (P = 0.025) and negativity of p63 (P = 0.025). There was no significant relationship between p53 or her2/neu overexpression and tumour stage. However, there was a significant correlation (P = 0.005) between p63 negativity and tumour stage. There was a significant relationship between p53 (P = 0.01), her2/neu (P = 0.025) overexpression and p63 negativity (P = 0.005) and tumour recurrence and progression. Conclusion Patients with transitional cell carcinoma who are selected for BCG treatment should preferably be positively immunoreactive for p63, but negative for both p53 and her2/neu. These patients were less susceptible to recurrence and/or progression after BCG adjuvant therapy. Further studies are needed to investigate the relationship between these three markers and treatment with anti-her2/neu therapies.

The diagnosis of azoospermia represents a major challenge to andrologists as this condition may occur despite normal spermatogenesis and genital tracts. Myeloid cell leukemia-1 (Mcl-1) is a member of the Bcl-2 family of proteins involved in regulation of apoptosis in various cell types. This study aimed to investigate the immunohistochemical expression of Mcl-1 in testicular biopsies of subjects with azoospermia. Eighty-six cases with azoospermia were obtained from 509 infertile patients admitted to the Andrology Unit of the Zagazig University Hospitals from January 2010 to December 2011. Biopsies were diagnosed and classified using H&E-stained slide sections. The specimens were subjected to immunohistochemical staining for Mcl-1 and examined through light microscopy. Forty-five cases of maturation arrest (25 at spermatids and 20 at the spermatocytes), 31 cases of hypospermatogenesis (20 moderate and 11 severe), 5 cases of Sertoli cell-only syndrome, 2 cases of basement membrane hyalinization, and 1 case of tubular and peritubular sclerosis were observed. Normal spermatogenesis was detected in 2 cases. A strong positive immunoreaction in Leydig cells was observed among all investigated specimens. A moderate reaction was detected in spermatocytes and spermatozoa in cases of normal spermatogenesis and hypospermatogenesis, but a negative reaction was detected in cases of maturation arrest and germ cell aplasia. Apoptosis was found to be associated with decreased rate of spermatogenesis. High apoptosis rates may result in azoospermia, which can occur despite normal spermatogenesis and absence of duct obstruction.

sweet potato has high nutritional value, not only its content of polysaccrides and minerals but also, its vitamin content of carotenes. Orange- fleshed sweet potato (OFSP) varieties rich in βeta-carotene, a precursor of vitamin A is one of the least expensive sources of dietary vitamin A. Investigations on the use of sweet potato (Ipomea batata ) orange and white flour with wheat flour composite at various levels of substitution (10,20, and 30%) in cake production were carried out. Sweet potato flour can serve as a source of energy and nutrients (carbohydrates, βeta-carotene, minerals (Ca, K , Fe, P, and Z), can add natural sweetness, color, flavor and dietary fiber to processed food products. All types of cakes were evaluated chemically, and physically. Total energy from cakes ranged from 404.9 -361.82 K.cal. The chemical composition showed that fresh sweet potato had lower protein content (4.51- 2.96%) in orange and white verities respectively. Sensory evaluation results revealed that composite cake (10%, 20% and 30%) had no significant difference (p>0.05) in taste At 30% level orange sweet potato was the best in volume increase, softness and overall acceptability. On the other hand, cohesiveness decreased with time, but increased with increased sweet potato flour in the cake. The shelf life of the produced cake increased for 30 days with cold storage.

Objective To evaluate of efficacy of transgluteal (supine) approach for shock wave lithotripsy (SWL) in treatment of distal ureteric stones. Patients and methods This prospective, randomized, comparative study was conducted on 98 patients. Patients were randomly assigned into 2 groups: group A (n = 49; prone position) and group B (n = 49; supine position, transgluteal). Inclusion criteria included patients with radiopaque lower ureteric stones ≤10 mm. Exclusion criteria included radiolucent stones, stones >10 mm, the need for any auxiliary procedure, and any contraindication for SWL. Post-SWL evaluation included plain x-ray of kidney, ureter, and bladder at 2 weeks after treatment and then at monthly intervals after treatment for 3 months. Stone-free status was defined as no residual stone fragments visible on plain x-ray. Treatment failure was defined as persistence of stone fragments at 3 months or the need for ureteroscopy. Results Stone-free rate after 1 treatment session was achieved in 44.9% and 75.5% for prone and supine positions, respectively. Proceeding to ureteroscopy, after failure of the second SWL session to clear the stones, was done in 34.7% and 8.2% for prone and supine positions, respectively. The overall success rate for SWL treatment in prone and supine groups was 65.3% and 91.8%, respectively ( P Conclusion Transgluteal SWL while patient in supine position proved efficacy for treatment of distal ureteric stones. Larger group studies comparing the results of SWL in supine position with those of prone position and also with those of ureteroscopy may enrich our data to reach a consensus for the ideal management of distal ureteric stones.

Penile curvature is a common urological disease. Tunical plication for correction of penile curvature has been much popularized being simpler, adjustable to avoid overcorrection, less bleeding, and less postoperative erectile dysfunction. This study aims to assess the results of modified 16-dot plication technique for correction of congenital and acquired penile curvature and avoidance of knot-associated complications. Eighteen patients underwent correction of their penile curvature using the modified 16-dot plication technique between January 2014 and October 2015. Patients’ pre and postoperative data were analyzed. The mean age of patients is 44 years old. Of the patients 15 who were available for follow-up, 8 patients had congenital penile curvature (CPC) and 7 had Peyronie’s disease (PD). The angle of deviation ranged from 30° to 90°. Erectile function (EF) was assessed preoperative by IIEF score and duplex ultrasound. Postoperative follow-up at 3 and 6 months revealed straight erect penis in all patients. Longer follow-up at 1 to 2 years, 2 patients complained from slight recurrence of curve (

Background and study aim: Hepatic steatosis in hepatitis C virus (HCV) infected patients has been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy. The current study is designed to investigate the impact of hepatic steatosis on the outcome of pegylated interferon and ribavirin combination therapy in patients with chronic hepatitis C genotype 4. Patients and Methods: A total number of 200 patients were selected from 270 patients who were referred to HCV Treatment Unit of New Mansoura General Hospital from February 2012 to August 2013 after taking an informed consent. They were 129 males and 71 females, their ages ranged from 25 to 55 years (mean value, 35.5±15.2). They had proven chronic hepatitis C virus based on history of exposure, clinical manifestations, positive anti-HCV antibody, positive HCV viremia, and liver biopsy findings suggestive of chronic hepatitis C. Results: Group I: included 100 patients (70 men and 30 women; mean age of 42.9±12 years) without liver steatosis. Group II: included 100 patients (59 men and 41 women; mean age of 45.23±11 years) with liver steatosis. In terms of steatosis grading using the NAS and METAVIR scoring systems, 50% had no staetosis while 8.5% had mild staetosis, 18.5% had moderate steatosis and 23% had severe steatosis. Body mass index of patients receiving interferon is significant between both groups. Hepatomegaly shows significant values between both groups. Platelets count, ALT, AST, S.Cholesterol & S.Triglycerides levels has statistically significant differences between group I (non steatotic) and group II (steatotic). There is statistically significant difference between both groups on necro-inflamatory activity grades. High statistical significance difference between grading of steatosis and Necro-inflammation. Statistical significance difference between grading of steatosis and fibrosis stages. Statistical significance difference between both groups at SVR and Steatosis has a negative effect on SVR by comparison to non steatotic group. High degree of hepatic steatosis has a negative impact on pagylated interferon and ribavirin therapy in chronic HCV genotype 4 minimizing sustained virologic response rates. Conclusion: Our study confirms that hepatic steatosis correlates with BMI, S.cholesterol, S.triglycerides, fibrosis, necro-inflammatory stages and has a negative impact on response to antiviral therapy.

Objectives To compare surgical outcomes and donor site complications of buccal and lingual mucosa used as ventral onlay graft for complex hypospadias cases. Patients & methods Forty four cases with complex hypospadias after failed previous surgery were prospectively included. All had severely scarred penile skin with reasonable residual urethral plate. Cases were categorized into two groups: Group I (23) where buccal mucosal graft [BMG] was used and group II (21) where lingual mucosal graft [LMG] was used. Donor site complications as well as functional and esthetic outcomes were recorded for each group. Results Mean follow up was 20.8 months (range 12–24). Average graft harvesting time was 24 min for BMG and 19 min for LMG. Donor site pain was reported with both techniques but recovery was earlier with LMG. Slurred speech and difficult tongue protrusion were reported with lingual but not buccal grafts; however mouth tightness, peri-oral numbness and persistent oral discomfort were reported only with buccal grafts. Successful urethroplasty was obtained in 78.2% of BMG compared to 76.1% of LMG. Conclusion Surgical outcomes of LMG urethroplasty were comparable to those of BMG in complex hypospadias cases. Compared to buccal mucosa, LMG is easy to harvest, with minimal donor site complications.

Objective To compare the technical aspects, operative time, safety and effectiveness of percutaneous nephrolithotomy (PCNL) in the free-flank modified supine position (FFMSP) vs. the standard prone position (SPP). Patients and methods Seventy-seven patients (47 men and 30 women) with renal stones were enrolled and systematically randomised into two groups, A (39 patients) treated using the FFMSP, and B (38 patients) in the SPP. The outcome was considered as a cure (successful procedure) if the patient became stone-free or had residual fragments of

Introduction: The inflatable penile prosthesis (IPP) has been used to treat erectile dysfunction for 40 years. Loss of penile length following IPP remains the single biggest patient complaint. We describe a preoperative and postoperative patient preparation protocol to assist in setting realistic patient expectations and decreasing the complaint of reduced penile length. Materials & Methods: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the post-operative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer. Results: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years. Conclusions: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.

Summary To evaluate the cytoprotective effects of rutin, ozone and their combination on adriamycin (ADR)-induced testicular toxicity, 50 male albino rats were classified into five groups of ten animals each as follows: placebo group; ADR group; ADR + rutin group; ADR + ozone group and ADR + rutin + ozone group. Sperm functions, testosterone (T), luteinising hormone (LH), follicle stimulating hormone (FSH), testicular enzymes, oxidant/antioxidant status, C-reactive protein, monocyte chemoattractant proteins-1 and leukotriene B4 were determined. After ADR injection, a decline in sperm functions was observed. FSH and LH levels were increased, T level and testicular enzymes were decreased, significant enhancement in oxidative stress with subsequent depletion in antioxidants was detected and inflammatory markers were significantly elevated. Treatment with rutin and/or ozone, however, improved the aforementioned parameters. Ozone therapy alone almost completely reversed the toxic effects of ADR and restored all parameters to normal levels.

Introduction: To evaluate the efficacy of adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for renal stones. Materials and Methods: This prospective study was conducted on patients who underwent single-session SWL for solitary renal stone less than 20 mm. Post-SWL, patients were randomly divided into 2 groups; the tamsulosin group (TG), received a daily dose of tamsulosin 0.4 mg, for a maximum of 12 weeks, with post-SWL traditional analgesia and control group (CG), received the traditional analgesia alone. Results: The study enrolled 271 patients and eventually only 249 (123 in TG and 126 in CG) completed the study. The overall stone free rate was 73.5%: 78.0% in TG and 69.0% in CG (p = 0.108). In TG, 8.1% of patients experienced at least one episode of acute renal/ureteral colic compared with 19.8% of controls (p = 0.008). The mean cumulative analgesia dosage per subject was 313 mg in TG and 346 mg in CG (p < 0.001). Overall, 14 patients developed steinstrasse and 6 of them (all in CG) needed urgent intervention (p = 0.031). Conclusions: Daily tamsulosin therapy does not enhance the clearance of stone fragments but decreases the pain episodes, analgesia dosage and need for adjuvant intervention after SWL for renal stones.

Objective To explore whether a “no touch” enhancement to the surgical technique of inflatable penile prosthesis (IPPs) implantaion will further decrease infection rates. Materials and Methods A single surgeon performed 2347 IPPs between January 2002 and June 2011. Patients receiving each manufacturer's implants were stratified for age and diabetes. Since 2003, infection retardant–coated IPPs were implanted through the standardized penoscrotal approach. Since 2006, the “no touch” enhancement was added to the surgical procedure. Infection rates in the noncoated IPP, coated IPP with standard technique, and coated IPP implanted with “no touch” enhancement were calculated and subjected to statistical analysis. The two company's implants were scrutinized for their individual infection rates in each group. Results Patients in all the groups were similar for age and diabetes. 132 noncoated implants had an infection rate of 5.3%. In the years 2003-2005, 704 coated devices had a statistically significant improvement in incidence of infection to 2%. In the years 2006-2010, the “no touch” technique enhanced the standard surgical procedure in 1511 patients. Only 7 infections were seen yielding an infection incidence of 0.46%. There was no difference in the two manufacturer's infection rates. Differentiation between virgin and revision operation displayed no bias in the infection rate. Conclusion Infection-retardant coatings lower the risk of infection from 5.3% to 2%. The “no touch” enhancement to the surgical procedure further decreases the rate of infection to 0.46%. Neither manufacturer showed statistical superiority in survival from revision for infection.

Kidneys are dynamic organs and represent one of the major systems maintaining the body homeostasis; they are affected by many chemicals and drugs. Grape seed extract (GSE) has been targeted to prevent drug-induced renal toxicity.This study investigates the possible renoprotective effect of GSE against oxidative stress, renal impairment, and hypercholesterolemia (HC) induced by gentamicin (GM) and cholesterol-enriched diet. Seventy adult male Wistar rats (160 ± 10 g) were divided into seven groups: (1) served as control, (2) GSE, (3) GM, (4) GSE + GM, (5) hypercholesterolemic (HC) group, (6) GM + HC group, and (7) GM + HC + GSE. Kidney functions, inflammatory mediators, cytokines, lipid profile, nitric oxide (NO), cyclic guanosine monophosphate (cGMP), and oxidative and antioxidative stress parameters were assessed in all groups.GM induced renal dysfunction, which was exacerbated by the presence of HC as confirmed by laboratory determinations. Administration of GSE attenuated the renal toxicity evidenced in significant reduction in elevated kidney function, inflammatory cytokines as well as lipid profile, NO, cGMP, enzymatic, and nonenzymatic antioxidants.Administration of GSE simultaneously with GM attenuated oxidative stress, diminished renal toxicity, and improved lipid profile induced by GM and HC.

Gentamicin (GM) is an effective antibiotic against severe infection but has limitations related to nephrotoxicity. This study investigates whether green tea extract (GTE), an antioxidant, could ameliorate the nephrotoxic effect of GM in uninephrectomized rats.The right kidneys of 40 rats were surgically removed and 1 week later the animals were divided into four groups (n = 10). Group 1 served as control, Group 2 as GTE group, Group 3 as GM group, and Group 4 as GM+GTE group. Kidney function, inflammatory cytokine TNF-α, oxidant and antioxidant parameters of renal tissue, as well as histopathological studies were assessed.Injecting uninephrectomized rats with GM induced renal dysfunction as shown by significant elevations in serum creatinine and urea. Serum TNF-α and oxidative stress parameters (superoxide anion and lipid peroxides) were also significantly increased. On the contrary, antioxidative parameters [superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH)] were significantly decreased. Histopathological examination of renal tissue illustrated features of degeneration, marked cellular infiltration, tubular dilatation, and varying degrees of necrosis. GTE given to GM rats reduced these nephrotoxicity parameters. Serum creatinine, urea, and TNF-α were almost normalized in the GM+GTE group. The oxidative stress parameters were significantly decreased and the antioxidative parameters were significantly increased.GTE ameliorates GM-induced nephrotoxicity and oxidative damage by improving antioxidant defense and tissue integrity. Further human studies are necessary to demonstrate the antioxidant effects of GTE on renal diseases. Nevertheless, green tea (GT) may offer an inexpensive, nontoxic, and effective intervention strategy in subjects with a risk for GM-induced nephrotoxicity.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The subject of bladder preservation multimodality protocols in muscle invasive bladder TCC is not new. In our study, even in a highly selected group of patients, multimodality protocol with M-VAC and radiation therapy achieved suboptimal results at 1 year. This emphasized the role of radical cystectomy as the gold standard treatment for invasive bladder TCC. OBJECTIVE • To evaluate the efficacy of a bladder preservation multimodality protocol for patients with operable carcinoma invading bladder muscle. MATERIALS AND METHODS • In this prospective study, we included 33 patients with transitional cell carcinoma (TCC) (T2 and T3, Nx, M0) who were amenable to complete transurethral resection. • These patients refused radical cystectomy as their first treatment option. After maximum transurethral resection of bladder tumour (TURBT), all patients received three cycles of adjuvant chemotherapy in the form of methotrexate, vinblastin, adriamycin and cisplatin (MVAC) followed by radical radiotherapy. • Four weeks later, all cases had radiological and cystoscopical re-evaluation. • Complete responders were considered to be those patients who had no evidence of residual tumour. All patients were subjected to a regular follow-up by cystoscopy and tumour site biopsy conducted every 3 months. Abdomino-pelvic computed tomography and chest X-ray were conducted every 6 months. • The study endpoint was the response to treatment after completion of the first year of follow-up after therapy. RESULTS • Out of 33 eligible patients, a total of 28 patients completed the study treatment protocol. Their mean ± SD age was 56.7 ± 6 years. Trimodal therapy was well tolerated in most of cases, with no severe acute toxicities. After 12 months of follow-up, a complete response was achieved in 39.3% and a partial response in 7.1%, with an overall response rate of 46.4%. • By the end of the first year, disease-free survival was reported in 39.3%, whereas 25% were still alive with their disease, giving an overall survival of 64.3% for all patients who maintained their intact, well functioning bladders. • Tumour stage and completeness of transurethral resection of bladder tumour were the most important predictors of response and survival. T2 lesions had complete and partial response rates of 69.2% and 23%, respectively, whereas T3 lesions had rates of 40% and 13.3%, respectively (P= 0.001). • The response rate in patients who had complete TURBT was 82.6% vs 20% in those with cystoscopic biopsy only (P= 0.001). In addition, disease-free survival was 72.7% in T2 patients and 27.3% in T3 patients (P= 0.001). CONCLUSION • In the present study, bladder preservation protocol with MVAC and radical radiotherapy achieved suboptimal response rates at 1 year in patients with localized TCC invading bladder muscle. Patients with solitary T2 lesions that are amenable to complete TURBT achieved the best response rates. Longer follow-up is needed to verify these results. Patients with localized disease should be encouraged for radical cystectomy, which achieved better results.

Refractory ischemic priapism results in cavernous smooth muscle necrosis, fibrosis and eventual penile shortening. Immediate penile implant insertion for acute ischemic priapism is done to avoid consequent fibrosis and shortening but ineffective shunt surgery trials may lead to potential weakness and erosion at the corporeal tip. We evaluate nonabsorbable sling sutures to fix the implant cylinder in place and prevent protrusion through the weak corporeal tip.We prospectively evaluated 12 men who presented with prolonged refractory ischemic priapism a median of 120 hours (range 60 to 168) in duration. All patients were unresponsive to conventional treatment and 11 had undergone unsuccessful shunt surgery. Early malleable penile prosthesis implantation had been done in all cases. To avoid possible distal protrusion a nonabsorbable sling suture was taken through the cylinder and the edges of the opened tunicae albuginea to fix the cylinder to the corporotomy edges.Penile implants were successfully inserted in all patients. No intraoperative or early postoperative complications were noted except in 1 with sickle cell priapism, in whom dilation led to unilateral corporeal perforation, which was managed intraoperatively. All patients were satisfied with the surgical results. No distal erosion was noted through the weak corporeal tip. No postoperative infection was reported at a median followup of 15 months (range 6 to 36). All patients successfully achieved sexual intercourse.Early penile prosthesis insertion for acute ischemic priapism is simple and successful. Distal cylinder protrusion through the defective corpora due to previous shunt surgery remains to confound surgical success. Nonabsorbable sling suture of the cylinder to the tunica albuginea is effective, simple and safe treatment for this formidable complication.

Introduction Parylene coating was added to the silicone layers of the American Medical Systems (AMS) 700 controlled expansion (CX) penile prosthesis cylinders in January 2001. The coating was placed on non-tissue contacting silicone surfaces to increase lubricity, reduce friction, and silicone wear Aim We compared mechanical reliability of the original and Parylene-enhanced AMS 700 CX in a large single surgical group series Methods Seven hundred seventy-five consecutive patients receiving the AMS 700CX prosthesis (596 first time [virgin] and 179 revisions) were followed for 3 years. Four hundred fourteen received the non-coated model and 361 received the Parylene-coated device. Revision-free survival was estimated using the Kaplan–Meier product limit method and compared using the log-rank test. Main Outcome Measures We calculated overall survival from revision for any reason and survival from mechanical problems such as fluid leakage, cylinder, connector or tubing breakage, pump or reservoir defects. Results For the entire series (virgin + revised) the 3-year revision free survival for any cause improved from 78.6% for non-coated to 87.4% for the Parylene-coated implants. Freedom from mechanical breakage showed similar improvement from 89.2% for the non-coated to 97.5% for enhanced models. Conclusion This study documents that short-term mechanical reliability and survival from revision for any cause is significantly increased with Parylene-coated AMS 700CX cylinders compared with the earlier AMS 700CX model with non-coated cylinders. Salem EA, Wilson SK, Neeb A, Delk JR, and Cleves MA. Mechanical reliability of AMS 700 CX improved by Parylene coating. J Sex Med 2009;6:2615–2620.

Introduction. Premature ejaculation (PE) is a worldwide problem without an approved treatment. Selective sero- tonin reuptake inhibitors (SSRIs) are widely used "off label" as pharmacotherapeutic agents in the treatment of PE. Aim. This study investigates Tramadol efficacy for on-demand treatment of PE. Main Outcomes Measures. Intravaginal ejaculation latency time (IELT) was used as an objective tool to assess the efficacy of the investigated treatments. Materials and Methods. Single-blind, placebo-controlled, crossover, stopwatch monitored two-period study was conducted, on 60 patients with lifelong PE. PE was defined as IELT of < 2 minutes in 80% of intercourse episodes. A total of 25 mg of Tramadol hydrochloride was given to one group (30) prior to intercourse and placebo was supplied for the other group (30) for 8 weeks. Drugs were taken 1-2 hours before sexual activity and sexual intercourse was required at least once per week. After the initial treatment period, the two groups took the alternate medication for another 2 months. The two 8-week treatment periods were separated by 1 week washout period. IELT was timed by a stopwatch at each intercourse and was reported by patients or partners. Results. The baseline (mean ± SD) IELT for patients before treatment was 1.17 ± 0.39 minutes. At the end of the treatment period utilizing the active drug, the mean IELT was increased significantly in patients on Tramadol treatment to 7.37 ± 2.53 minutes. The same patients on placebo medication had mean IELT of only 2.01 ± 0.71 minutes. Patients uniformly reported satisfaction with their resulting control over ejaculation. Conclusions. Tramadol, a drug with a proven safety record as an anti-inflammatory agent, shows promise as a drug for treating rapid ejaculation. Salem EA, Wilson SK, Bissada NK, Delk JR II, Hellstrom WJ, and Cleves MA. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med 2008;5:188-193.

Objectives: In this retrospective study we reviewed the outcome of non-operative management of high-grade blunt renal injuries (grade III–V) and evaluated the predictive indicators of management failure. Subjects and methods: The data review included the patients’ demographics, the mechanism of trauma and the clinical characteristics, as well as the laboratory and imaging data upon admission and at follow-up. The data of the patients who were successfully managed non-operatively and of those who needed intervention for renal injuries were compared. Results: Two hundred and six patients were enrolled in this study. Grade III, grade IV and grade V renal injuries were found in 39.8%, 44.2% and 16% of the patients, respectively. The overall success rate of non-operative management was 87.9%, including all patients with grade III, 86.8% of patients with grade IV and 60.6% of those with grade V injuries. Multivariate analysis revealed that trauma secondary to motor vehicle accident, hypotension at presentation, associated injuries to other organs, grade V renal injury and computed tomography (CT) imaging features, namely medial renal parenchymal laceration, perirenal hematoma ≥3.5 cm and intravascular extravasation were significant predictors for failure of non-operative management. Conclusion: Our findings suggest that high-grade renal injuries in hemodynamically stable patients can be managed conservatively with a high success rate. Multiple clinical and radiological variables can predict the treatment outcome. Keywords: High grade; Non-operative management; Outcome; Renal trauma

Cadmium is a toxic heavy metal in the contaminated environment which accumulates in different organs of the human and animal. Cd exposure leads to the production of reactive oxygen species present study was performed to evaluate the effect of cadmium on the biochemical criteria (ROS). The related to oxidative stress in kidney, liver and testis of adult male rats and to clarify the protective effect of pre and post treatment with lycopene on these criteria. The results showed that cadmium treatment caused significant elevations in liver and kidney weights, serum creatinine, urea, uric acid, aspartate aminotransferse (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamaglutamyltransferase (GGT), and lactate dehydrogenase (LDH) with significant reductions in weights of testes, epididymis, seminal vesicles and prostate, serum total protein and plasma testosterone. It also markedly increased lipid peroxidation and cadmium concentration in kidney, liver and testis tissues, while significantly decreased superoxide dismutase (SOD), catalase (CAT) activities and reduced glutathione in the tissues of the three organs. Cadmium intoxicated rats showed also considerable increase in the percentages of dead sperms and abnormal sperm rate, while marked decrease in sperm concentration and sperm motility as compared to the control group. Pre-supplementation with lycopene prevented degenerative changes induced by cadmium, reduced oxidative stress and restored the biochemical changes occurring in kidney, liver and testis tissues to near normal group (control). In addition pretreatment with lycopene was more effective than post- treatment in reversing almost all hepatorenal and testicular parameters.

Objectives Inflatable penile prosthesis (IPP) infection remains a devastating surgical complication. American Medical Systems recently introduced an IPP with a coating of minocycline HCL and rifampin (InhibiZone). We report our experience with this coating and compare the rate of infection with our historical rate. Methods A total of 467 patients receiving InhibiZone-coated IPPs were followed up for infection. The patients were stratified into four groups: nondiabetic, first-time (virgin) implants; diabetic, virgin implants; revision without washout; and revision with antiseptic solution washout. All patients were observed for longer than 1 year. The infection rates were compared with our published data of noncoated IPPs. Results No infections developed among the 223 virgin implants in nondiabetic patients. Of the 83 diabetic patients with virgin implants, 1 developed an infection (1%). Of the 39 revision patients without washout, 4 (10%) had infections. When an antiseptic washout was used in patients requiring revision, the infection rate dropped to 3% (4 of 123). Compared with our previous publications of infection rates with noncoated implants, InhibiZone-coated IPPs showed a statistically significant reduction in infection in virgin nondiabetic, virgin diabetic, and revision with washout implants. No reduction in the infection rate occurred among revision patients without washout. Conclusions Antibiotic-coated implants become infected less often in virgin, nondiabetic and virgin, diabetic patients than in our historical experience with noncoated implants. However, antibiotic-coated implants used in revision surgery did not reduce the infection rate unless adjunctive antiseptic solution washout was also used.

Introduction Long-term revision-free survival, greater than 10 years has never been reported for inflatable penile prostheses. We conducted a historical prospective study to estimate 10 and 15 years survival of first time (virgin) implantations in 2,384 patients with four different models. Aim Evaluation of 10- and 15-year mechanical and overall revision-free survival of inflatable penile prostheses. Main Outcome Measures Kaplan–Meier product limit method, and comparison using the log rank test, were used to estimate the 10- and 15-year revision-free survival. Methods Data were obtained from medical records and patient interviews, entered into a computerized database, and analyzed by a third party. Information included implant type, date, revision history with date, and reason. Fourteen different inflatables were examined. Mentor Alpha 1, Mentor Alpha NB, AMS 700 CX, and AMS 700 Ultrex had usage for an extended period of time. Because of failure times being confounded as a result of prior implants, only virgin implants were examined. Results For the entire series, estimated 10-year revision-free survival for all reasons was 68.5% and the 15-year revision-free survival was 59.7%. Freedom from mechanical breakage at 10 years was 79.4%; 15 years was 71.2%. Recent mechanically enhanced models did even better. In 1992, Mentor Alpha added pump reinforcement to forestall mechanical breakage. This improved 10-year survival from 65.3% to 88.6% ( P = 0.0001). In January 2001, AMS CX added a parylene coating to the cylinders that increased 3-year mechanical survival from 88.4 to 97.9% ( P = 0.0002). Conclusions This is the first report on long-term reliability of inflatable penile prostheses. We estimated 60% of these virgin implants would survive 15 or more years without revision or extraction. Newer enhanced models are currently available, and our tracking predicts even better long-term survival for these devices. Wilson SK, Delk JR, Salem EA, and Cleves MA. Penile prostheses: Single surgical group experience with 2,384 first-time implants spanning two decades.

Introduction Placement of an inflatable penile prosthesis in a patient with scarred corporal bodies secondary to priapism or removal of a previously infected implant is a formidable surgical challenge; use of downsized implants has improved chances of successful reimplantation. Nevertheless, patients are frequently dissatisfied with the resulting short penises. Aim This study investigates the use of downsized inflatable penile prosthesis cylinders as tissue expanders in patients with corporal fibrosis. Main Outcomes Measures Corporal length and width were calibrated before implantation of downsized prostheses and after 1 year of their use as tissue expanders. Methods Thirty‐seven patients had insertion of Mentor Narrow Base (18), AMS CXM (9), or AMS CXR (10) into scarred corporal bodies. Etiology was previously infected and removed implant (29) or priapism (8). In each of these cases it was not possible to dilate to 12 mm in order to place standard‐sized cylinders. Patients were encouraged to inflate their implant for up to 3 hours daily. After several months intracorporal stretching occurred. The patients were reoperated; corporal length and width were recalibrated. Results Upon reoperation, it was possible to pass dilators of 12 mm width proximally allowing the substitution of standard‐sized AMS 700 CX (23), Mentor Alpha 1 (10), or Mentor Titan (2). Additionally, corporal length measurements in the previously infected patients increased an average of 2.2 cm allowing placement of longer cylinders. Although priapism patients did not show this phenomenon of corporal lengthening, the implant space widened enough to permit replacement with standard‐size cylinders improving girth, rigidity, and appearance. Conclusions Wider and sometimes longer cylinders can be substituted in patients with corporal fibrosis that required implantation with downsized cylinders because of fibrotic corpora. Prolonged inflation over an 8‐ to 12‐month period results in expansion of the cylinder cavity, permitting standard‐sized cylinders in all patients. Wilson SK, Delk JR, Mulcahy JJ, Cleves M, and Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med 2006;3:736–742.

Isolated pump erosion is a rare complication in patients with inflatable penile prosthesis. We describe a case of a diabetic patient who underwent inflatable penile prosthesis implantation with subsequent isolated pump erosion. Repeated attempts of conservative repair of the erosion failed. Finally, the inflatable penile prosthesis was replaced with a malleable one to avoid new pump erosion. In case of isolated pump erosion, replacement of the inflatable penile prosthesis with a malleable one looks to be a good alternative salvage treatment for the patient.

To evaluate the use of lingual mucosal graft (LMG) as a substitute for tunica albuginea in the treatment of Peyronie disease (PD).Seventeen patients, reporting normal erectile function, with PD interfering with sexual function were operated on by plaque excision and grafting with LMG. Preoperative assessment included: the International Index of Erectile Function-5 score, penile duplex, and penile curvature angle measurement. Postoperative erectile function and penile deformity were assessed every 3 months for 9-18 months.Mean age of the patients was 52 (± 4.7) years and mean angle of deformity was 60° (± 5.1). Donor site complications occurred in the form of mild transient swelling, numbness, and pain. Postoperative assessment showed complete penile straightening in 15 patients with mild curvature recurrence (20°) in 2 patients at the third month. De novo mild erectile dysfunction was reported by 1 patient who responded to low-dose phosphodiesterase type 5 inhibitor. Patients' and partners' satisfaction was reported in 16 (94%) patients. These results remained stable until the end of the follow-up period.LMG seems to be a valuable substitute for tunica albuginea in cases of PD. It is readily available and shows early graft take. It also proved safety, reliability, feasibility, and a satisfactory short-term outcome for the treatment of PD.

Objectives: The recurrence of HCV post liver transplantation endangers patient and graft survival. The aim of this study is to analyze the risk factors for HCV recurrence, the effect of the recurrence and its management on the outcome of liver transplantation. Materials and methods: After exclusion of the 6 months mortality, dual HCV and HCC patients, about fifty five HCV related LDLT patients were enrolled in the study and were followed up from 6 to 60 months. Demographic, preoperative, intraoperative and postoperative data were studies. HCV recurrence was defined by elevated transaminases, positive serum HCV RNA and liver biopsy findings. Univariate and multivariate analysis were done on all data to detect the favoring factors of HCV recurrence. Results: HCV recurrence occurred in 21/55 of the patients and one of them developed cirrhosis on follow up. By univariate analysis; CMV infection, mean operative time (12.490 ± 1.8952), acute cellular rejection and pulse steroids treatment were predictors of HCV recurrence (P

Introduction: The inflatable penile prosthesis (IPP) has been used to treat erectile dysfunction for 40 years. Loss of penile length following IPP remains the single biggest patient complaint. We describe a preoperative and postoperative patient preparation protocol to assist in setting realistic patient expectations and decreasing the complaint of reduced penile length. Materials & Methods: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the post-operative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer. Results: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years. Conclusions: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.

The liver is a common site of metastases. The most relevant metastatic tumor of the liver to the surgeon is colorectal cancer because of the well-documented potential for long-term sur‐ vival after complete resection. However, a large number of other tumors commonly meta‐ stasize to the liver, including cancers of the upper gastrointestinal system (stomach, pancreas, biliary), genitourinary system (renal, prostate), neuroendocrine system, breast, eye (melanoma), skin (melanoma), soft tissue (retroperitoneal sarcoma), and gynecologic system (ovarian, endometrial, cervix). [1]

This procedure may be considered when inserting a semi-rigid prosthesis in men with a scrotal web, requiring only a single scrotal skin incision to achieve both subcoronal corporotomies and a reduction scrotoplasty. The reduction scrotoplasty procedure might enhance patient perception of penile length and improve overall satisfaction with penile implant surgery. Using the scrotal skin incision prevents the need for circumcision but allows for minimal-sized subcoronal corporotomies, and permits a multilayered closure with nonoverlapping suture lines. Artificial erection is developed with saline via butterfly needle using a penile tourniquet. A penoscrotal incision is used to avoid circumcision and to remove scrotal web Typical location of incision for circumcision Scrotal web

Objective To investigate the potential protective effects of selenium and lycopene, either alone or in combination, for cisplatin-induced oxidative stress and testicular dysfunction in male rats. Methods A total of 50 adult male Wistar rats were divided into 5 groups of 10 animals each, as follows: control group (treated with placebo); cisplatin-alone group; cisplatin + lycopene group; cisplatin + selenium group; and cisplatin + selenium + lycopene group. The weights and dimensions of testes, epididymes, and accessory glands as well as sperm concentration, motility, and proportion of normal morphology were assessed. Testicular tissue malondialdehyde (MDA) and glutathione (GSH) levels, as well as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities, and plasma testosterone were determined. Results Cisplatin treatment caused significant reductions in weights and dimensions of testes, epididymes, and accessory glands, sperm concentration, motility, and proportion of normal morphology, enzymatic and nonenzymatic antioxidants, and plasma testosterone levels. There was significantly increased MDA. The co-administration of selenium and lycopene, either separately or in combination, significantly attenuated the harmful effects of cisplatin-induced lipid peroxidation, oxidative stress, loss of genital organ weight and dimensions, as well as function of reproductive organs collectively in the Wistar rat model. The combination of selenium and lycopene was more effective than supplementation of either agent alone in preventing cisplatin-induced testicular damage. Conclusion Selenium and lycopene supplementation reduced cisplatin-induced testicular toxicity, improved testicular function and prevented cisplatin-related injury to the rat testes by suppression of oxidative stress.