Effect of varicocelectomy and/or mast cells stabilizer on sperm DNA fragmentation in infertile patients with varicocele.

This study aimed to assess the effect of varicocelectomy and/or mast cells (MCs) stabilizer on sperm DNA fragmentation in infertile men with varicocele (Vx). Overall, 120 infertile patients were randomized to three equal treatment arms; patients that underwent varicocelectomy, patients on 1 mg ketotifen twice daily for three months, and patients that underwent varicocelectomy followed with 1 mg ketotifen twice daily for three months. These patients were subjected to history taking, clinical examination, semen analysis, and estimation of sperm DNA fragmentation index (DFI). After 3 months, all investigated groups showed significant improvement regarding the mean total sperm count, sperm concentration, total sperm motility, and sperm normal forms percentage compared with the pre-treatment data. As well, the mean sperm DFI was significantly improved compared with the pre-treatment data; in men that underwent varicocelectomy (34.6% vs. 28.3%), in men on MC stabilizer only (33.4% vs. 27.8%), and in men that underwent varicocelectomy followed by MC stabilizer (34.3% vs. 25.1%). Sperm DFI improvement percentages showed the highest improvement in men that underwent varicocelectomy followed with MC stabilizer compared with the other two groups (26.8% vs. 18.2%, 16.8%). Sperm DFI improvement percentages showed significant increases in the infertile patients with Vx grade III compared to Vx grade II in all investigated groups. It is concluded that in infertile men associated with Vx and high sperm DFI, surgical repair followed with MCs stabilizer significantly improve sperm DFI compared with either surgical repair or MCs stabilizer alone.

A pilot study of penile hemodynamics in men with penile curvatures.

Penile curvature (PC) is bothersome to the patient. PC is either congenital or acquired. In most of the circulatory system, blood flows in a laminar profile with minimal energy expenditure. When a fluid passes in a curved tube, the laminar profile is disturbed and changed into a turbulent flow. It increases the energy expenditure and reduces the flow. Turbulent flow may have a role in the development of an atherosclerotic plaque and in localizing its site. The aim of this research was to study penile hemodynamics before and after correction of PC. This prospective study included 20 participants, with PC more than 30°. For each participant, preoperative color duplex doppler ultrasonography (CDDU), correction of the curvature using 16 dot plication technique and post-operative CDDU were done. Furhtermore, arterial systolic velocity was estimated distal to the site of curvature/correction every 5 min for 25 min. The degree of curvature ranged from 30° to 90° with a mean of 55±18.98. Comparative study between the preoperative and post-operative data proved a significantly higher postoperative peak systolic velocity distal to the site of correction, whereas CDDU data had insignificant differences. We concluded that correction of PC is associated with improvement of penile arterial blood flow distal to the site of correction.

Short-term use of sildenafil in the treatment of unconsumated marriages.

The aim of this study is to evaluate the effectiveness of short-term sildenafil use in the management of unconsummated marriages diagnosed to be mainly psychogenic in origin. This retrospective study included 35 patients evaluated within an Andrology clinic. Patients underwent a complete medical and sexual history as well as a focused physical examination. Investigations were ordered as necessary following a goal-directed approach. Education about the male and female genital anatomy and the sexual response cycle was carried out, as well as a detailed explanation about the concepts of performance anxiety, vaginismus and the mode of action of sildenafil. Sildenafil on demand therapy was initiated for 1 month and the duration extended as needed. Of 35 patients included in our study, 32 (91%) were able to achieve vaginal intromission and perform sexually. In all, 23 patients needed the sildenafil (66%) for less than 1 month, five (14%) for up to 3 months and four (11%) for more than 3 months. Three patients (9%) were unsuccessful. Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause. We conclude sildenafil use is effective as a short-term treatment option in the management of unconsummated marriages.