Nocturnal penile erections: A retrospective study of the role of RigiScan in predicting the response to sildenafil in erectile dysfunction patients.

Sildenafil enhances the nitric oxide-cGMP pathway of erection, which is claimed to have a role in nocturnal penile tumescence and rigidity (NPTR). This study aimed to find whether RigiScan can predict the response to sildenafil among erectile dysfunction (ED) patients and to find which RigiScan parameter produces the best prediction. Medical records of 172 ED patients were revised regarding their full sexual history, standard andrology examination, NPTR monitoring by the RigiScan device, and the degree of response to sildenafil. Of 172 ED patients, 94 patients (54.7%) were sildenafil responders. All RigiScan parameters were higher in the sildenafil responder group. The RigiScan parameters with the most differentiating power between both sildenafil responders and non-responders were base rigidity (AUC 0.860) and then tip rigidity (AUC 0.831). The cut-off value of base and tip rigidity with the highest diagnostic accuracy was 42.5%. This finding was found to be more specific than the sensitivity in predicting a positive response to sildenafil (85.9% vs. 70.2% and 92.3% vs. 59.6%, for base and tip rigidity, respectively). Sildenafil response in ED cases can be predicted through NPTR monitoring using the RigiScan device and ED patients with RigiScan base or tip rigidity less than 42% are not expected to respond well to sildenafil.

Hydrocortisone relieves the immediate post-operative scrotal edema after inguinal varicocelectomy: A prospective clinical trial.

This study aimed to assess the effect of a single IM injection of hydrocortisone succinate in relieving the immediate post-varicocelectomy scrotal edema. In all, 117 patients with grades II and III varicocele who developed post-varicocelectomy scrotal edema were randomly classified into group A (n = 59) that received a single IM hydrocortisone sodium succinate injection plus ordinary post-operative treatment and Group B (n = 58), which received the post-operative treatment alone. All patients were followed up to assess; changes in scrotal edema, the day of return to work and emergence of complications. Post-operative scrotal edema was assessed using a scrotal edema rating grades (SERG = 0-3) score. In group A, scrotal edema disappeared 1 day after steroid injection in 33 patients (55.9%), and after 2 days in the remaining 26 patients (44.1%), and all patients were returned to work within 5-7 days. In group B, the edema remained large in 36 patients (62.1%), moderate in 22 patients (37.9%), and disappeared after 9-12 days; and those patients returned to work within 11-13 days. It is concluded that a single IM hydrocortisone injection could be effective to reduce the immediate post-operative scrotal edema after inguinal varicocelectomy without obvious side effects.

Interleukin-17A rs2275913, Interleukin-17F rs763780 and rs2397084 gene polymorphisms as possible risk factors in Juvenile lupus and lupus related nephritis.

UNLABELLED: There are no reports about the association of interleukin (IL)-17A and IL-17F gene polymorphism and susceptibility to pediatric systemic lupus erythematosus (pSLE). OBJECTIVE: To examine the possible role of IL-17A rs2275913, IL-17F rs763780 and rs2397084 polymorphisms as risk factors for pSLE in a cohort of Egyptian children and to investigate their association with the clinico-pathological features including lupus nephritis (LN). METHODS: Typing of IL-17A and IL-17F polymorphisms was done using restriction fragment length polymorphism for 115 children with SLE and 259 age- and sex-matched healthy controls. RESULTS: No significant differences were found between pSLE patients and healthy controls for the allele and genotype frequencies of IL-17A rs2275913, IL-17F rs763780 and rs2397084 (p > 0.05). However, the combined genotype GGAGAA and the haplotype GGA had significant association with pSLE (pc = 0.042 and <0.001, respectively). The AA genotype of IL-17F rs763780 is more frequent in female patients (p = 0.002) and the AA genotype of IL-17F rs2397084 is more associated with positivity of ds-DNA (p = 0.007). No more associations were found for the demographic and clinical data of pSLE patients including risk of LN development, risk of non-remission, overall survival, activity and chronicity indices. CONCLUSION: The GGAGAA combined genotype and the GGA haplotype of IL-17A rs2275913, IL-17F rs763780 and rs2397084 can be considered risk factors for the development of SLE in Egyptian children. IL-17A rs2275913, IL-17F rs763780 and rs2397084 are not related to the LN development, SLE disease activity or overall survival.

Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens.

OBJECTIVE: To assess the relationship between paternal age and the outcome of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection (ICSI) in patients with congenital bilateral absence of the vas deferens (CBAVD). DESIGN: Prospective cohort study. SETTING: In vitro fertilization centers. PATIENT(S): Eighty-five (male) CBAVD patients who underwent percutaneous epididymal sperm aspiration with ICSI were divided into 3 age groups; <30 years (n = 27); aged 30-40 years (n = 32); and aged >40 years (n = 26). INTERVENTION(S): History taking, clinical examination, semen analysis, percutaneous epididymal sperm aspiration with subsequent ICSI. MAIN OUTCOME MEASURE(S): Sperm retrieval, clinical pregnancy, and "take-home baby." RESULT(S): The number of sperm retrieved by percutaneous epididymal sperm aspiration significantly decreased with advancing age in the studied groups (0.63, 0.31, and 0.18 million, respectively), concomitant with significant decreases in the outcomes of clinical pregnancy (55.5%, 43.7%, and 23.1%, respectively) and "take-home baby" (48.1%, 40.6%, and 11.5%, respectively). Male age was significantly negatively correlated with retrieved sperm count, sperm motility, sperm vitality, and normal sperm morphology. Multiple logistic regression, adjusted for confounding factors, with male age, and sperm count obtained using percutaneous epididymal sperm aspiration, was significant. The receiver operating characteristic curve showed that a sperm count of 0.55 million as a cutoff value could predict clinical pregnancy with an accuracy of 77.4%, with 82.9% sensitivity and 62% specificity, and "take-home baby" with an accuracy of 81.7%, with 93.1% sensitivity and 62.5% specificity. CONCLUSION(S): In cases of CBAVD, male age has a negative effect on retrieved-sperm count, motility, vitality, and normal sperm morphology; number of retrieved sperm predicted both clinical pregnancy and "take-home baby" outcomes in subsequent ICSI.

Tumor necrosis factor-α gene polymorphism relationship to seminal variables in infertile men.

OBJECTIVE: To assess the tumor necrosis factor (TNF)-α gene polymorphism relationship with seminal variables in fertile men (N) and those with asthenozoospermia (A), asthenoteratozoospermia (AT), and oligoasthenoteratozoospermia (OAT). MATERIALS AND METHODS: A total of 50 infertile men without a female factor who were attending a fertility clinic and 48 fertile men were randomly screened for semen analysis, analysis of the TNF-α promoter region for polymorphism, seminal caspase-9, acrosin activity, α-glucosidase, and reproductive hormones. RESULTS: The TNF-α GG genotype was present in 83.9%, 72.7%, 66.7%, and 59.5%, the TNF-α AA genotype in 3.2%, 6.8%, 10.4%, and 11.9%, and TNF-α AG genotype in 12.9%, 20.5%, 22.9%, and 28.6% in the N, A, AT, OAT groups, respectively. The occurrence of A allele was significantly greater among infertile patients than among fertile controls (21.6% vs 9.7%; odds ratio 0.388, 95% confidence interval 0.2 to 0.75, P = .005). Men with the TNF-α AA genotype demonstrated a significant decrease in the sperm count, sperm motility, normal sperm morphology, acrosin activity, and seminal α-glucosidase and a significant increase in seminal caspase-9 compared with those with the TNF-α GG genotype. CONCLUSION: This single nucleotide polymorphism in the TNF-α(-308) gene was associated with significantly increased seminal caspase-9 and a significantly decreased sperm count, sperm motility, normal sperm morphology, acrosin activity, and seminal α-glucosidase.

Nocturnal penile erections: the role of RigiScan in the diagnosis of vascular erectile dysfunction.

INTRODUCTION: To determine the etiology of cases with organic erectile dysfunction (ED), invasive techniques are needed that can induce patient anxiety and disturb test results. AIM: To find any special patterns of nocturnal penile tumescence and rigidity (NPTR) records in cases of vasculogenic impotence that can differentiate cases of arterial and venous origin without resorting to the more invasive diagnostic tests. METHODS: This study included 95 cases of ED (77 cases with abnormal NPTR records plus 18 cases with normal NPTR). History taking and clinical examination with estimation of serum androgen hormones and postprandial blood glucose were done. All patients were then subjected to the following: NPTR monitoring using RigiScan device (Dacomed Corporation, Minneapolis, MN, USA), pharmacopenile duplex ultrasound examination, and redosing pharmacocavernosometry. According to the results of these tests, patients were classified into four groups: psychogenic, arteriogenic, venogenic, and combined arteriogenic-venogenic ED groups. Receiver operator characteristic (ROC) curve analysis of the different RigiScan parameters of venogenic group vs. the arteriogenic group was done. Best parameters were then retested by using them in prediction of veno-occlusive dysfunction (VOD) in all studied patients. MAIN OUTCOME MEASURES: Different RigiScan parameters: number of events, duration of best episode, base tumescence, base rigidity, tip tumescence, and tip rigidity. RESULTS: RigiScan parameters were statistically lower in venogenic than in arteriogenic group and were more correlated with flow to maintain than the peak systolic velocity. ROC curve analysis showed that VOD can be predicted if the duration of the best event is <11.5 minutes (diagnostic accuracy 83.7%) or tip rigidity is <36.5% (diagnostic accuracy 81.6%). On generalizing these values in all patients, duration of best event showed diagnostic accuracy of 88.4%. CONCLUSION: VOD can be predicted if duration of the best event of NPTR monitoring is less than 11.5 minutes, but the presence of concomitant arterial dysfunction cannot be excluded.

ACE gene insertion/deletion polymorphism seminal associations in infertile men.

PURPOSE: We assessed seminal associations of the ACE gene insertion/deletion polymorphism in infertile men. MATERIALS AND METHODS: A total of 405 men were investigated, divided into healthy fertile men, and those with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia, respectively. They underwent semen analysis, and assessment of sperm acrosin activity, hypo-osmotic swelling, seminal 8-iso-prostaglandin-F(2α), total antioxidant capacity, α-glucosidase and ACE gene polymorphisms. RESULT: The ACE insertion/insertion genotype was noted in 182 men, including 76.5% of healthy fertile men, and 47.4%, 39.8% and 17.6% of those with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia, respectively. The ACE insertion/deletion genotype was noted in 133 men, including 13.7% of healthy fertile men, and 42.3%, 27.5% and 47.2% of those with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia, respectively. The ACE deletion/deletion genotype was identified in 90 men, including 9.8% of healthy fertile men, 10.3%, 32.70% and 35.2% of those with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia, respectively. Men with the ACE deletion/deletion and insertion/deletion genotypes showed a significant decrease in sperm count, motility, linear velocity and normal forms, acrosin activity index, hypo-osmotic swelling test and seminal α-glucosidase, and significantly increased seminal 8-iso-prostaglandin-F(2α) than those with the ACE insertion/insertion genotype. CONCLUSIONS: ACE gene deletion polymorphism is associated with abnormal seminal variables, such that carriers of the ACE deletion/deletion genotype have higher seminal oxidative stress.

HLA-DRB1*15 confers susceptibility to juvenile SLE but is not associated with disease presentation: an Egyptian Study.

The etiology of Systemic lupus erythematosus (SLE) seems to be multifactorial including environmental as well as genetic factors. Major histocompatibility complex (MHC) genes especially HLA-DRB1 and HLA-DQB1 are strongly implicated in susceptibility to SLE. Moreover ethnicity has been found to have a significant role in both disease susceptibility and disease expression. This study was carried out to determine HLA-DRB1 allele association with SLE susceptibility and disease presentation in Egyptian children with juvenile onset SLE. HLA-DRB1 allele typing was done using polymerase chain reaction-sequence-specific oligonucleotide probe for 65 juvenile Egyptian SLE patients and 150 healthy controls. p-values were corrected for the number of the alleles tested (Pc). HLA-DRB1*15 g allele was significantly increased in SLE children versus controls (OR = 4.76; 95% CI = 1.83-12.4; p = 0.001 and Pc = 0.012). No HLA-DRB1 allele was found to be statistically significant associated with musculoskeletal, cutaneous, hematologic, cardiac or neuropsychiatric manifestations in SLE patients (p > 0.05). Moreover no statistically significant association was found between HLA-DRB1 alleles and clinical presentation or histologic classes of lupus nephritis. The current work suggests that HLA-DRB1*15g allele may be a susceptibility allele in Egyptian children with SLE but is not related to clinical presentation of SLE.

Varicocelectomy in men with nonobstructive azoospermia: is it beneficial?

OBJECTIVES: To investigate the effect of open lymph sparing high ligation varicocelectomy in nonobstructive azoospermic men with palpable varicocele and determine predictive parameters of outcome. METHODS: After a standard diagnostic evaluation, a total number of 83 men with nonobstructive azoospermia (54 men with complete azoospermia and 29 with virtual azoospermia) and palpable varicocele underwent open lymph sparing high ligation varicocelectomy. Testicular core biopsy was also performed perioperatively in all patients. Varicocelectomy was performed bilaterally in 60 patients and unilaterally in 23. The outcome success was assessed in terms of improvement in semen parameters and spontaneous pregnancy. Four patients with recurrent varicocele were excluded from final data analysis. RESULTS: After a mean follow up of 7.4 months, motile sperm in the ejaculate could be identified in 27 (34.2%) nonobstructive azoospermic patients with a mean postoperative sperm count of 3.56+/-4.8 x 106/mL (range 0.3-18.9) and a mean sperm motility of 42.24+/-17.64% (range 24-76). No predictive parameters of postoperative improvement other than testicular histopathology could be concluded. Of these 27 patients, 2 had Sertoli-only-cell pattern, 6 had maturation arrest at spermatid stage pattern, 13 had hypospermatogenesis and 8 had normal spermatogenesis. Spontaneous pregnancy was achieved in 6 (7.7%) patients. Of these 6 patients, 2 had maturation arrest at spermatid stage pattern, 2 had hypospermatogenesis and 2 had normal spermatogenesis. No predictive parameters of spontaneous pregnancy achievement could be concluded. CONCLUSION: High ligation varicocelectomy may offer nonobstructive azoospermic men an opportunity to have motile sperm via ejaculate and even the chance of natural conception, instead of the more bothersome assisted reproductive techniques.

Comparison of different perrmeation enhancers on topical ketoconazole formulations.

The clinical efficacy of five ketoconazole (CAS 65277-42-1) topical formulations (three gels and two creams) was evaluated in 50 patients suffering from fungal infections in an open uncontrolled pilot study. Each formulation contained selected permeation enhancers providing high permeability in vitro. The patients were randomly divided into five groups each of ten persons. Each group was assigned to a selected topical formula which was applied to the diseased skin twice daily for four weeks or until complete clinical improvement. The clinical evaluation of treatment effects was based on the following criteria: size of lesion, erythema, scaling and severity of itching (four grades each). The patients were considered cured after the disappearance of these clinical symptoms and negative potassium hydroxide and Wood's light examination tests during the follow-up period. The results showed that the overall therapeutic response to the treatment was 96.7% and 93% for the hydroxypropylmethyl cellulose gel containing menthol and sodium carboxymethyl cellulose gel containing isopropyl myristate, respectively. Creams (w/o and o/w) achieved 90% and 87% improvement after 2.5 weeks, respectively. The lowest clinical response (86.5% improvement) with the longest duration of treatment (3 weeks) was observed with sodium carboxymethyl cellulose gel containing oleic acid.

Effect of cryptorchidism and retractile testes on male factor infertility: a multicenter, retrospective, chart review.

This multicenter retrospective chart review study performed on 162 cryptorchid patients and on 34 subjects with retractile testes suggests that cryptorchidism and retractile testes can alter spermatogenesis, with more serious damage observed in bilateral cryptorchidism. This spermatogenetic impairment is probably related to the lack of an appropriate or timely surgical correction.

Erectile dysfunction in smokers: a penile dynamic and vascular study.

In this study, we aimed to determine the hemodynamic mechanisms through which cigarette smoking, as an independent risk factor, induces erectile dysfunction (ED). We performed a standard ED evaluation that included history; a physical exam; and serum glucose, testosterone, and prolactin levels. We then excluded ED patients with abnormal androgen profiles and patients with ED risk factors other than smoking. A total of 109 ED patients entered the study, including 71 current smokers and 38 nonsmokers. All patients then underwent extensive evaluation, including nocturnal penile tumescence and rigidity (NPTR) monitoring with Rigiscan, followed by pharmacopenile duplex ultrasonography (PPDU) and redosing pharmacocavernosometry (RPC). Results of the above tests were compared in the smoker and nonsmoker groups. We also performed receiver operating characteristic (ROC) curve analysis to determine which diagnostic parameter is most affected by cigarette smoking. The 4 most significant variates served as input features for a logistic regression model, designed to predict smoking. The average age for smokers and nonsmokers was 44.3 and 51.2 years, respectively (P = .02). Eighty-six percent of smokers had abnormal NPTR testing compared with 55% of nonsmokers (P = .02). The average peak systolic velocity (PSV) was 26.8 and 31.2 cm/s for smokers and nonsmokers, respectively, and this difference was not found to be statistically significant (P = .19) in this study. On performing RPC, an abnormal maintenance flow (MF) of >5 mL/min was detected in 89% of smokers and in 47% of nonsmokers, and the difference was significant (P < .01). With the use of smoking as the outcome, the ROC area of different diagnostic parameters was as follows: 0.79 for penile base rigidity, 0.58 for PSV, and 0.77 for MF. A logistic regression model that used the 4 most significant variates as input features yielded a ROC of 0.857. The results of NPTR testing in our smoker and nonsmoker groups indicated that ED in smokers is mainly of organic etiology. On the basis of the PPDU findings and the higher incidence of abnormal MF in the smoker group and its relatively high ROC value, we concluded that dysfunction of penile veno-occlusive mechanisms plays a substantial role in the development of ED in smokers.

The influence of obstructive interval on patency rates following microsurgical epididymovasostomy.

To determine whether or not obstructive interval (OI) negatively affects patency rates in epididymovasostomy (EV) as a sole procedure alone, we reviewed medical records from obstructive azoospermia (OA) patients who underwent unilateral or bilateral epididymovasostomy. For the purpose of analysis, patients were placed into short OI (15 years or less) or long OI (more than 15 years) categories. Patency rate for the short OI group was 58%, compared to 15% for the long OI group (P<0.01). In conclusion, we observed that patency rates worsened with obstructive interval greater than 15 years. Epididymovasostomy is a challenging procedure that may not be successful, and, thus, patients should be counseled that obstructive interval might affect surgical outcomes. We routinely perform testicular sperm extraction (TESE) with sperm cryopreservation in this patient population due to the high likelihood that it will ultimately be required for assisted reproductive technology (ART).

The role of testicular biopsy in the modern management of male infertility.

PURPOSE: We evaluate the traditional role of isolated testicular biopsy as a diagnostic tool, as opposed to the value as a therapeutic procedure for azoospermic men. MATERIALS AND METHODS: The medical records of azoospermic patients who were evaluated, and treated between 1995 and 2000 were retrospectively analyzed for history, physical examination findings, endocrine profiles, testicular histology and sperm retrieval rates. Based on these parameters, cases were placed into diagnostic categories that included obstructive or nonobstructive azoospermia. Diagnostic parameters used to distinguish obstructive from nonobstructive azoospermia were subjected to statistical analysis with the t-test, analysis of variance and receiver operating characteristics curve. RESULTS: A total of 153 azoospermic men were included in our analysis. Of men with obstructive azoospermia 96% had follicle-stimulating hormone (FSH) 7.6 mIU/ml. or less, or testicular long axis greater than 4.6 cm. Conversely, 89% of men with nonobstructive azoospermia had FSH greater than 7.6 mIU/ml., or testicular long axis 4.6 cm. or less. Receiver operating characteristics analysis revealed that FSH, testicular long axis, and luteinizing hormone were the best individual diagnostic predictors, with areas 0.87, 0.83 and 0.79, respectively. CONCLUSIONS: In the vast majority of patients obstructive azoospermia may be distinguished clinically from nonobstructive azoospermia with a thorough analysis of diagnostic parameters. Based on this result, we believe that the isolated diagnostic testicular biopsy is rarely if ever indicated. Men with FSH 7.6 mIU/ml. or greater, or testicular long axis 4.6 cm. or less may be considered to have nonobstructive azoospermia and counseled accordingly. These men are best treated with therapeutic testicular biopsy and sperm extraction, with processing and cryopreservation for usage in in vitro fertilization and intracytoplasmic sperm injection if they accept advanced reproductive treatment. Diagnostic biopsy is of no other value in this group. Men with FSH 7.6 mIU/ml. or less, or testicular long axis greater than 4.6 cm. may elect to undergo reconstructive surgery with or without testicular biopsy and sperm extraction, or testicular biopsy and sperm extraction alone depending on their reproductive goals.

What nonresponse to intracavernous injection really indicates: a determination by quantitative analysis.

PURPOSE: In addition to its usefulness as a therapeutic modality, intracavernous injection may also be done in a diagnostic capacity. While a good response to an intracavernous injection test rules out venous leakage, a failed erectile response to the test in the office setting may not be completely representative of the patient erectile state. We determined by quantitative analysis the likely significance of failure to respond to intracavernous injection testing. MATERIALS AND METHODS: Patients evaluated with the standard erectile dysfunction assessment at our andrology clinic between 1996 and 1999 were included in analysis. All 122 patients who did not meet study exclusion criteria underwent a test dose of intracavernous injection with papaverine, phentolamine and prostaglandin E1. Regardless of the response or lack of response to the test the men then underwent nocturnal penile tumescence testing, penile blood flow study and re-dose pharmacocavernosography. Results of these adjunctive tests were compared to the outcome of a papaverine, phentolamine and prostaglandin E1 intracavernous injection test by quantitative analysis. RESULTS: A total of 87 patients failed to respond to the test dose. Average age of the nonresponders versus responders was 46.8 versus 33.8 years. The duration of erectile dysfunction in nonresponders versus responders was 31.0 versus 13.7 months. Poor intracavernous injection responders required an average of 1.9-fold greater induction flow and 6-fold greater maintenance flow than good responders. Receiver operator characteristics (ROC) curve analysis revealed that the best predictors of the intracavernous injection test response were erectile dysfunction duration (ROC 0.99), patient age (ROC 0.87), maintenance flow (ROC 0.86), pressure loss (ROC 0.83) and resistive index (ROC 0.82). The ROC area for peak systolic velocity was 0.69. CONCLUSIONS: Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.