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We aimed to determine the level of miRNAs 16 and 135a in lifelong premature ejaculation (LPE) patients versus controls. Moreover, we evaluated the potential interplay between the studied miRNAs and fluoxetine in these patients after utilizing fluoxetine daily for 3 months. The study involved 60 consecutive LPE patients and 20 healthy age matched individuals as controls. The median miRNA16 was significantly higher in the controls (1.02) compared to the patients (0.31) (p 0.001). Moreover, the median miRNA-135a was significantly higher in the controls compared to the patients 1.02 and 0.35, p 0.001, respectively. In addition, the median pre-treatment miRNA16 in the responders was 0.29 that significantly increased to 0.66 (p 0.001). The median pre-treatment miRNA-135a in the responders was 0.27 that significantly increased to 0.65 (p 0.001). Furthermore, considering EXP(β) for the odds ratio evaluation, with a 95% degree of confidence, a 1 fold increase in pre-treatment miRNA 135a fold change decreases the odds for being responsive to SSRI by 0.028. Meanwhile, there was non-significant association between fluoxetine responsiveness and age, pre-treatment miRNA 16, pre-treatment PEDT and pre-treatment IELT. The current study had shown that a lower pre-treatment miRNA 135a was significantly associated with response to fluoxetine.

The aim of the study was to detect the incidence and types of genital and renal duct anomalies associated with congenital absent vas deferens (CAVD). In 200 males with CAVD, the demographic characteristics, physical examination findings were evaluated. Scrotal ultrasonography and transrectal ultrasonography (TRUS) were used as the diagnostic methods for evaluating unilateral or bilateral CAVD with associated abnormalities or agenesis of the testes, epididymes, seminal vesicles and prostate. Abdominal ultrasound was performed to detect any associated renal anomalies. There were a total of 111 CBAVD and 89 CUAVD males. Eight cases (8.98%) of CUAVD were associated with contralateral cryptorchidism. In most cases there were agenesis in the epididymal body and tail and seminal vesicles. Different types of renal anomalies (32.50%) especially renal agenesis were observed mainly in cases of left CUAVD and were predominately on the left hand side. An important implication of our study is the importance of requesting ultrasound of males with CAVD to discover any associated anomalies especially renal agenesis that may be ignored by many physicians.

Background and objectives Testicular sperm extraction (TESE) has been a useful diagnostic and therapeutic tool with sperm retrieval opportunity varying according to the pathological finding in azoospermic patients. Sonoelastography (SE) is an exciting radiologic method that can measure relative elasticity of different tissues in a selected region of interest (ROI) by depending on fast cross-correlation technique and a combined autocorrelation method. Real-time elastography (RTE) can be used for structural analysis of testicular tissue to detect pathological tissue alterations. We aimed in the current study to evaluate the efficacy of shear wave elastography (SWE) in predicting sperm retrieval in non-obstructive azoospermic (NOA) patients undergoing TESE. Patients and methods This prospective study included 50 NOA patients who did two successive semen analyses with normal or elevated gonadotrophic hormones. All participants were subjected to SWE imaging on the testes by a radiologist. The measurements were recorded in terms of kPa using the SWE mode. They were done on each testis in the longest longitudinal plane. SWE images were viewed using dual mode: elasticity mode (kPa) and propagation (arrival time contour) mode then patients underwent TESE. Results A significant difference in SWE values was observed between patients with successful sperm retrieval and those with negative sperm retrieval providing 94.7% negative predictive value and 50.0% positive predictive value for sperm retrieval in NOA patients undergoing TESE with 75.0% sensitivity and 85.71% specificity (p = 0.0001). Mean stiffness index measured by SWE correlated significantly with the histopathological types as 8 patients only were diagnosed as having severe hypospermatogenesis. Discussion and conclusion These prime data suggest that SWE as a non-invasive, easily applicable, and repeatable imaging method has a promising potential to be one of the reliable sonographic modalities that can be used as one of the predictors for sperm retrieval in NOA patients.

Objective: To evaluate sexual functions of patients with erectile dysfunction (ED) and their female partners. Methods: A total of 90 consecutive ED patients who received different ED therapies and their partners and 90 consecutive controls and their partners were divided into four groups. All participants were evaluated by the 15-item international index of erectile function and the Arabic version of female sexual function index (Ar-FSFI). Results: All ED patients who received sildenafil demonstrated significant improvements of their erectile function compared to baseline. Their partners did not demonstrate improvements in frequency of pain during vaginal penetration (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), confidence of becoming aroused (3.86 ± 0.58, 3.93 ± 0.45, p 0.477), frequency of satisfaction with arousal (3.07 ± 0.37, 3.03 ± 0.49, p 0.712), and maintenance of lubrication (4.37 ± 0.49, 4.23 ± 0.73, p 0.354). All ED patients who received quadmix demonstrated significant improvements of their erectile function compared to baseline. Their partners did not demonstrate improvements in desire level (2.6 ± 0.67, 2.63 ± 0.85, p = 0.869) and lubrication maintenance (3.53 ± 0.82, 3.47 ± 0.82, p = 0.423). Finally, All ED patients who underwent semi rigid penile implant demonstrated significant improvements of their erectile function compared to baseline. Their female partners demonstrated significant improvements in all items of FSFI-19 compared to baseline except the frequency of pain during vaginal penetration (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), confidence of becoming aroused (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), frequency of satisfaction with arousal (3.07 ± 0.37, 3.03 ± 0.49, p = 0.712), and maintenance of lubrication (4.37 ± 0.49, 4.23 ± 0.73, p = 0.354). Conclusions: Sexual functions of ED males significantly improved after ED therapies. Nevertheless, some sexual functions of their partners were not positively impacted.

We aimed to find a correlation between the intraoperative diameters of the seminiferous tubules evaluated at high magnification during micro-testicular sperm extraction (micro-TESE) and total motile sperm count (TMSC) in non-obstructive azoospermic (NOA) patients. Five hundred four consecutive NOA patients were included and underwent micro-TESE. The change in the mean TMSC and different seminiferous tubular diameters was of high statistical significance (p p

Aim: We aimed in this survey to assess fertility and reproductive health awareness among medical students. Methods: A total of 354 female and male final year medical students (193 females and 157 males) were recruited for this survey at the Kasr Al-Ainy Faculty of Medicine, who attended the lectures of the andrology and sexually transmitted disease department. Results: Our study demonstrated that the mean ages of the female and male medical students when they want to have their first child were 26.95 ± 2.924 and 28.7 ± 3.94, respectively, and and p = 0, while the mean ages of the female and male medical students when they want to have their last child were 32.5 ± 3.2 and 34.7 ± 5.1, respectively, and p = 0.001. Our study demonstrates that a majority of the female and male medical students moderately estimated the efficacy of the assisted reproductive technique to take a baby home, and the means of their estimation were 42.620% ± 12% and 43.5% ± 13.1% and p = 0.482. Moreover, our study showed that 75 (39.1%) females were convinced that vaginal delivery has a potential negative effect on the sexual functions. However, 99 (51.6%) females did not see any potential negative effect of vaginal delivery. In addition, 18 (9.4%) females responded in an indefinite way to this question. Finally, our study demonstrated that 145 (92.4%) males rejected the proposal of vasectomy. Conclusions: Interestingly, our study revealed increased estimation by the participants of the efficacy of the assisted reproductive technique to take a baby home, despite the fact that they were medical students who had already studied the subject of gynecology in their fifth year and should have estimated it properly.

Purpose: The aim of this prospective study was to determine whether there is a beneficial role of combining gonadotropin administration with testosterone downregulation in non-obstructive azoospermia patients prior to a second time microsurgical testicular sperm extraction after a negative one. Methods: A total of 40 non-obstructive azoospermia men were recruited from a specialized IVF center from 2014 to 2016. Participants were divided equally into two groups: Group A was subjected to testosterone downregulation alone for 1 month and then combined with gonadotropin administration for 3 months prior to second time testicular sperm extraction; Group B (controls) underwent second time microsurgical testicular sperm extraction without prior hormonal therapy. Results: Mean baseline follicle-stimulating hormone levels of the controls and the cases were 26.9 ± 11.8 and 25.4 ± 8.7, respectively. One month after testosterone downregulation, follicle-stimulating hormone level of the cases was normalized and became 2.4 ± 1.2. There was no statistically significant difference between baseline follicle-stimulating hormone levels of the controls and cases (p = 0.946). Remarkably, two cases were positive after downregulation (10%) and no controls were positive at second testicular sperm extraction (0%). There was no statistically significant difference between sperm retrieval after the second microsurgical testicular sperm extraction in the controls and the cases (p = 0.072). Conclusion: Patients who underwent first time testicular sperm extraction with unfavorable outcome due to different techniques may benefit from testosterone downregulation combined with neoadjuvant gonadotropin administration as it had shown positive sperms retrieval in 2 out of the 20 cases, especially those with hypergonadotropic azoospermia.

This study aimed to screen healthy individuals who contracted COVID‐19 for erectile dysfunction (ED) and to determine the potential risk factors that can predict ED in these individuals. One hundred and seven cases versus 90 controls agreed to participate in the study. Two structured interviews with 1 month interval were conducted. All participants were evaluated by the validated Arabic version of the international index of erectile function (IIEF‐5) and assessment of the psychological state by Hamilton depression rating scale (HDRS). Interestingly, the study had demonstrated a significant difference in mean testosterone level between cases and controls (3.91 ± 2.31, 5.04 ± 2.22, p

Erectile dysfunction (ED) is a common condition with a significant impact on the quality of life. Regenerative medicine maladies are intended to repair or replace damaged tissues and organs through different therapeutic mechanisms. Our aim was to study the effect of intra-corporeal injection (ICI) of platelet-rich plasma (PRP) in ED patients. Thirty-four patients' erectile function was evaluated by filling up an abridged form of the international index of erectile function (IIEF-5) before and after PRP therapy. ICI of PRP was done once per week for 2 months. All patients were prescribed PDE5Is for one month after PRP therapy. Penile haemodynamics was assessed using 20 µg of PGE1 before and 3 months after initiating PRP therapy. Interestingly, our study had shown that there was a statistically significant difference in the IIEF-5 score after ICI of PRP (-5.5, ±5.2, p=

We studied prospectively the role of FSH, testis volume, age, duration of infertility, hormonal therapy, varicocelectomy and testicular histopathology in determining the sperm retrieval rate (SRR) in fresh versus salvage micro-TESE. Our study analysed retrospectively the prospectively maintained database of 330 NOA patients who underwent micro-TESE either 1st or 2nd or 3rd timers from January 2017 to August 2018 from the Andrology Clinic of a specialized IVF centre. They were divided equally into 3 groups, group (1) were 1st timers, group (2) were 2nd timers and group (3) were 3rd timers, respectively. Interestingly, our study demonstrated a positive correlation between high FSH level and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.015). Additionally, our study revealed a positive correlation between age and favourable micro-TESE outcome in 2nd timers who underwent micro-TESE (p 0.031). Further, our study revealed a positive correlation between right testicular volume and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.023). Eventually, there was a significant positive correlation between histopathology which was mainly sertoli cell only syndrome and favourable micro-TESE outcome in 1st timers micro-TESE (p 0.001). Our study demonstrates that sperms can be retrieved despite high FSH level, and preoperative histopathology is not essential in predicting SRR in NOA patients. Further, age can be considered a good prognostic factor in patients who undergo salvage micro-TESE for the 2nd time.

The purpose of the study was to compare serum level of folic acid (FA) in patients with erectile dysfunction (ED) versus healthy controls and to assess its correlation with other well-known confounders for ED. Our prospective study compared FA in 60 patients with ED versus 30 healthy controls. Patients were excluded if they had any hormonal disorders, Peyronie’s disease, or decompensated systemic illnesses. ED was evaluated by the validated Arabic version of the abbreviated five-item form of the International Index Of Erectile Function and confirmed by penile duplex. Serum FA level was assayed using ELIZA. Mann–Whitney, Kruskal–Wallis, and Chi-square tests and Spearman correlation were used as appropriate and confirmed by logistic regression model. Our study revealed that the median FA of the cases and the controls were 7.1 ng/mL and 13.4 ng/mL, respectively, and this difference was of high statistical significance (p

We aimed to study the risk factors of erectile dysfunction (ED) and different patterns of phosphodiestrase type 5 inhibitors (PDE5is) usage among Egyptian patients.One thousand five hundred consecutive Egyptian patients complaining of ED were included in this cross-sectional study from July (2014) to October (2015). Patients were requested to answer the international index of erectile function questionnaire (IIEF-5). Statistical differences between groups were tested using Chi square test and Spearman's rho correlation coefficient for qualitative variables.Remarkably, significant associations between IIEF scores and aging and diabetes mellitus (DM) and hypertension (HTN) and ischaemic heart disease (IHD) and hyperlipidaemia were shown in the studied patients (p.0001, p.0001, p.0001, p.0001, p.0001, respectively). Eventually, our study showed significant correlations between different age groups and morning erection and lower urinary tract symptoms and HTN and IHD and DM where the severity of ED was directly proportional to the absence or decreased strength of morning erection with aging and the increased incidence of LUTS and HTN and IHD and DM with aging (p.0001; p=.001; p.0001; p.0001; p.0001, respectively).Our study demonstrated that aging; DM, HTN and hyperlipidaemia are potential major risk factors of ED in Egypt for further validation. In addition, most of the participants used PDE5is without prior medical consultation together with concomitant administration of illicit drugs.

Headache is one of the chronic disorders that can trigger sexual dysfunction due to complex mechanisms. This study recruited 120 consecutive patients from our outpatient clinics with migraine (n = 60), TTH (n = 60) as well as healthy age-matched controls (n = 60) for a total of 180 patients. All the participants were evaluated by the Arabic version of the female sexual function index (ArFSFI: 19 items), the abridged 5-item version of the international index of erectile function (IIEF-5), hospital anxiety and depression scale (HADS: 14 items), visual analog scale (VAS) score, and the headache impact test questionnaire (HIT-6TM: 6 items). A significant correlation was noticed between scores of total ArFSFI in women with TTH and their partners’ IIEF-5 scores (r = 0.773, p

This study aimed to demonstrate the effect of conventional freezing versus cryoprotectant-free vitrification on the recovery of testicular sperm motility. Testicular samples were obtained from 50 patients with azoospermia for testicular biopsy ± potential sperm storage. We retrieved 100 spermatozoa from each patient divided equally into two straws. They were frozen using conventional freezing as a control group and cryoprotectant-free vitrification in micro-capillary system using open-pulled straws. Seven days later, cryopreserved straws were thawed and assessed in duplicate. The mean sperm motility between the original spermatozoa sample and the post warming sample was reduced after conventional freezing compared to cryoprotectant-free vitrification (4.48 ± 2.09% versus 3.25 ± 1.92%, p < 0.001; 4.48 ± 2.09% vs 3.68 ± 1.93%, p < 0.001, respectively). There was a significant difference between the two methods regarding the mean sperm motility after warming (3.38 ± 1.86% versus 3.76 ± 1.88%, p = 0.015). The mean recovery percent of testicular sperm motility from the original sperm sample was lower (p = 0.02) after conventional freezing compared to cryoprotectant-free vitrification (78.4 ± 28.17% versus 85.37 ± 23.63%). Overall, the rate of post-thaw recovery of human testicular sperm motility improved using cryoprotectant-free vitrification compared to conventional freezing.

Introduction Bipolar disorder is an episodic mood disorder that causes unusual shifts in mood and affects the ability to carry out day-to-day tasks. Aim Evaluation of the sexual function in men and women with bipolar disorder during remission. Methods 60 men and women with bipolar disorder and 60 age-matched control subjects were included. A Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition was performed to confirm the diagnosis, and Hamilton Depression Rating Scale (HAM-D) to assess the depressive symptoms and Young Mania Rating Scale (YMRS) to assess the manic symptoms. We assessed sexual function in both sexes using international indices of erectile function for men and sexual function of women. Main Outcome Measures Scores of HAM-D, YMRS, Arabic versions of International Index of Erectile Function (IIEF) and female sexual function (FSFI). Results Depressive symptoms showed insignificant adverse correlation with the IIEF in men, whereas they revealed adverse significant correlations with the items of female sexual function index (FSFI) except pain (correlation coefficients [r] = 0.349 [P = .059], r = 0.680 [P < .001], r = 0.574 [P = .001], r = 0.517 [P = .003], r = 0.569 [P = .001], r = 0.532 [P = .002], r = 0.609 [P < .001], r = 0.342 [P = .065], respectively). Interestingly, the manic symptoms were associated with sexual hyperfunctioning in the men and were insignificantly correlated with the different items of FSFI in the women (r = 0.414 [P = .023], r = 0.043 [P = .821], r = 0.100 [P = .601], r = 0.108 [P = .571], r = 0.183 [P = .332), r = 0.086 [P = .651], r = 0.022 (P = .907), r = 0.109 [P = .565], respectively). There was a positive correlation between the affected women’s satisfaction and their partners’ score (r = 0.374, P =.042). Finally, the mean score of pain was statistically higher in the female cases than the normal ones (mean ± SD = 3.6 ± 0.4, 3.4, ± 0.6; P = .036). Clinical implications A different approach may be mandatory for manic female patients. Strengths & Limitations This study is one of the few studies that evaluated the sexual function in patients with bipolar disorder especially during remission. Some limitations of this study must be mentioned. We failed to evaluate the female partners of the diseased males. Quality of life of the recruited patients was not assessed. Finally, the study included patients who were not drug free. Conclusion Manic symptoms in female bipolar I patients are associated with sexual hypofunctioning.

A 46 year-old male presented suffering from refractory erectile dysfunction. The patient had a past history of pelvic chondro-sarcoma. This case was a challenge for us; the surgery performed for excision of the sarcoma has resulted in the elimination of both pubic ramia together with excision of part of both corpora and left hemiscrotum. The procedure included a sling application on one side with a mesh sock wrapped around the rear part of the extendor cylinder. Another sling was applied on the contra lateral side without a mesh sock.

Tribulus terrestris is an annual herb of the Zygophyllaceae family and is commonly known as Gokshur, Gokharu, or puncturevine. Flavonoids, alkaloids, saponins, lignin, amides, and glycosides are the main active phytoconstituents of this plant. Infertility is defined by the failure to conceive a child after one year or more of regular unprotected sexual intercourse. Infertility affects society at large and has a negative impact on the social and emotional aspects of the patient. This in-depth review presents several studies that evaluate the role of Tribulus terrestris in a chronological order to help us better understand the exact mechanism by which this herbal medicine acts in male infertility. In conclusion, the exact role of Tribulus terrestris in male infertility is still controversial and needs future double-blind placebo-controlled studies that deploy larger cohorts.

OBJECTIVE To evaluate the association between miRNAs and veno-occlusive erectile dysfunction. Recently, this association between miRNAs and erectile dysfunction was extensively studied using animal models. Our aim was to explore the miRNAs expressions and functions in the development of erectile dysfunction, especially veno-occlusive dysfunction, using a human tissue. PATIENTS AND METHODS We prospectively recruited 60 patients with erectile dysfunction and controls between July 2015 and July 2016. The 30 patients had refractory veno-occlusive erectile dysfunction that was proven by investigations. They were scheduled for penile implant. The 30 controls were scheduled for repair of their fracture. We measured miRNAs (200a and 206) and nitric oxide in cavernous tissue and serum of both patients with erectile dysfunction and controls. RESULTS A significant association was found between the 2 mentioned miRNAs and erectile dysfunction (P

Erectile dysfunction is a highly prevalent disorder. It is estimated that more than 50% of men who ranged in age from 40 to 70 years old suffer from erectile dysfunction to some degree. We aimed in this pilot cross-sectional study to determine female sexual function and social satisfaction before and 6 months after penile prosthesis implant. This study was carried on 50 consecutive married women whose husbands underwent malleable penile prosthesis implant in our department from July 2015 to July 2016. Our results showed significant increase in desire, lubrication, orgasm, and satisfaction scores after 6 months of penile prosthesis operation compared to scores before penile prosthesis implant (p

A cross-sectional survey was conducted in Egypt from November 2015 to June 2016. Sexually active adult men were interviewed by a questionnaire designed by the authors. All the participants were evaluated by the abridged 5-item version of the International Index of Erectile Function (IIEF). A total of 3,000 sexually active Egyptian males participated in this study, 946 (31.53%) reported using PDE5Is at least once, and 2054 (68.47%) have never used them. The majority of those who used PDE5Is obtained them for recreational purposes mainly for pleasure (58.35%) and to increase duration/frequency of the intercourse (15.6%). Only 26.05% used PDE5Is to treat ED. The main source of obtaining PDE5Is was friends, relatives and colleagues (62.79%); 25.16% of users obtained the drug by themselves, and 6.66% were prescribed the drug by a pharmacist. Only 5.39% of users obtained the drug after a specialist physician consultation. Sildenafil was the most commonly used PDE5I (90.6%), and most of the users (88.05%) used them in an occasional manner even in the presence of erectile dysfunction, while 11.95% used the drug in a regular manner for every intercourse. PDE5Is are frequently used by the Egyptian male population, and most of them seemed to take them as recreational medications.

We evaluated the role of Tribulus terrestris in males with unexplained infertility and its effect on serum testosterone and semen parameters. Thirty randomized male patients presenting to Andrology outpatient clinic complaining of idiopathic infertility were selected. They were given Tribulus terrestris (750 mg) in three divided doses for three months. The effect of Tribulus terrestris on serum testosterone (total and free) and luteinizing hormone (LH), as well as its impact on semen parameters in those patients, was studied. No statistically significant difference was observed in the levels of testosterone (total and free) and LH and semen parameters (sperm concentration or motility, or abnormal forms) before and after the treatment. In addition, no statistically significant correlations were observed between testosterone (free and total) and LH and semen parameters before and after the treatment. Tribulus terrestris was ineffective in the treatment of idiopathic infertility.

Aging is associated with a series of morphological and functional modifications that leads to reduced physiological efficiency and atrophy of various organs and systems. Tribulus terrestris induces its effect in fertility and sexual functions through the steroidal saponins, particularly the dominant saponins protodioscin. We aimed in this study to evaluate the efficacy and safety profiles of Tribulus terrestris in aging males with partial androgen deficiency who suffered from erectile dysfunction and lower urinary tract symptoms. A total of 70 randomized aging patients with erectile dysfunction and lower urinary tract symptoms were recruited from June 2017 to March 2018 from our andrology outpatient clinic. Thirty-five patients (group A) received Tribulus terrestris three times daily for 3 months and the other 35 patients (group B) received placebo. The mean of aspartate transaminase was elevated in group A after 3 months of receiving Tribulus terrestris (26.5 (before), 27.8 (after), respectively, p = 0.03). Moreover, there were significant elevations in the means of both total testosterone together with the score of the validated Arabic index of erectile function (5-item version of the International Index of Erectile Function) (2.2, 10.7 (before), 2.7, 16.1 (after), p

We aimed in this retrospective study to evaluate non-surgical preoperative parameters and testicular histopathology in determining the sperm retrieval rate (SRR) in non-obstructive azoospermic (NOA) patients. We evaluated the data of 1,395 consecutive patients who underwent 1st time micro-dissection testicular sperm extraction (micro-TESE) that was done by fifteen different senior andrologists and a consequent undefined number of biologists assisting them in the operative rooms from January 2010 to May 2013 in a specialised IVF centre. Our study did not demonstrate any statistical significance between the mean age, the mean duration of infertility and finally, the mean of FSH levels of the patients with positive and negative micro-TESE outcomes (p-value 0.391, 0.543, 0.767 respectively). Moreover, our study did not demonstrate any association between different types of hormonal therapy prior to micro-TESE and patients with positive micro-TESE outcome (p-value 0.219). Interestingly, our study showed positive associations between the testicular histopathology SCO (sertoli cell only syndrome) and high FSH and sperm retrieval rate (p < 0.001, 0.02 respectively). Logistic regression analysis revealed high statistical significance between sperm retrieval rate and high FSH level and testicular histopathology (OR 1.6, 0.21, 95% CI lower 1.2, 0.008 and upper 2.1, 0.06 and finally p 0.003