Early experience of "En bloc" holmium laser enucleation of the prostate in Saudi Arabia.

Purpose: Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. Patients and Methods: An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. Results: One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. Conclusions: HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.

Impact of Antioxidants on Conventional and Advanced Sperm Function Parameters: An Updated Review.

Antioxidants include diverse exogenous and endogenous compounds that can neutralize free radical activity, which ultimately protects sperm from oxidative stress (OS). Nevertheless, a controlled balance between oxidation and reduction is of paramount importance for cellular function. Excessive use of antioxidants should be avoided. A combination of antioxidants has been utilized to obtain a synergetic effect in the treatment of male infertility. Antioxidants have been shown to have a positive effect on semen parameters with a decrease in DNA damage. Future large randomized controlled trials are needed to determine the real impact of antioxidants on semen parameters, reproductive outcomes, and DNA integrity.

Initial Outcomes of Freehand Transperineal Biopsies Regarding Diagnostic Value and Safety: An Early Experience at King Fahad Specialist Hospital, Buraydah, Saudi Arabia.

BACKGROUND: Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989 which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, p=0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia. METHODS: This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure. RESULTS: The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients. CONCLUSION: We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.

Sperm retrieval and intracytoplasmic sperm injection outcomes with testicular sperm aspiration in men with severe oligozoospermia and cryptozoospermia.

INTRODUCTION: Several studies addressed the role of testicular sperm aspiration with intracytoplasmic sperm injection (ICSI) in azoospermic men, but few have included non-azoospermic men. The aim of this study was to evaluate testicular sperm aspiration (TESA) sperm retrieval rates and ICSI outcomes in men with severe oligozoospermia. METHODS: Data were collected retrospectively from 88 consecutive, non-azoospermic, infertile men with idiopathic severe oligozoospermia who underwent TESA between January 2011 and January 2018. Patients were categorized into four groups according to sperm concentration: <5 and >1 million/ml (group 1), <1 and > 0.1 million/ml (group 2), <0.1 million/ml (group 3), and cryptozoospermia (group 4). RESULTS: Mean male age was 37±7 years and the mean female age was 33±4 years. Sperm was recovered successfully in 90% (79/88) of the men overall and in 100% (30/30) of the men in group 1, 97% (29/30) of the men in group 2, 88% (15/17) of the men in group 3, and 45% (5/11) of the men in group 4. Most (65%, 57/88) of the couples had an embryo transfer (ET). The overall clinical pregnancy rate per ET was 46% (26/57). The clinical pregnancy rates (per ET) were 43% (9/21) in group 1, 65% (13/20) in group 2, 36% (4/11) in group 3, and 0% (0/5) in group 4. CONCLUSIONS: Our data indicate TESA allows for high sperm retrieval rates and acceptable ICSI pregnancy rates in men with severe oligozoospermia. However, in our experience, TESA sperm retrieval rates and ICSI outcomes are poor in cryptozoospermic men.

Use of mini-incision microdissection testicular sperm extraction in men with cryptozoospermia and non-obstructive azoospermia.

INTRODUCTION: Microdissection testicular sperm extraction (micro-TESE) is a procedure commonly utilized to harvest spermatozoa in severe male factor infertility. We have developed a technique involving a mini tunica albuginea incision with superficial tissue dissection (mini-incision micro-TESE). The modification is designed to reduce potential tissue injury, and we studied its effectiveness to harvest spermatozoa in men with cryptozoospermia and non-obstructive azoospermia. MATERIALS AND METHODS: We performed a retrospective analysis of 103 infertile men with NOA and cryptozoospermia who underwent a mini-incision micro-TESE between March 2015 and August 2018 at the OVO fertility clinic. We consider the mini-incision micro-TESE procedure successful when at least five spermatozoa are identified in the micro-biopsies obtained from the superficial tissue exposed by the 1-cm mini-incision. If no spermatozoa are identified through the mini-incision, we can easily extend the incision to the standard micro-TESE. RESULTS: The mini-incision procedure allowed for successful recovery of spermatozoa (intra-operative recovery of ≥ 5 spermatozoa) in 58% of men with cryptozoospermia and 25.6% of men with NOA. Overall, a successful sperm retrieval (with conversion to conventional micro-TESE if mini-incision was not successful) was achieved in 89% of men with cryptozoospermia and 48% of men with NOA. A successful mini-incision micro-TESE was associated with a significantly lower number of biopsies than conventional micro-TESE (8.8 vs 24.2, P < .0001). Moreover, in men undergoing a redo micro-TESE after a previously successful micro-TESE, 64% (9/14) had spermatozoa found and 21% (3/14) of these men only required a mini-incision micro-TESE. CONCLUSION: Our data suggest that mini-incision micro-TESE is a useful approach in men undergoing micro-TESE, allowing for a shorter incision and a high sperm retrieval rate in men with cryptozoospermia. Furthermore, the findings of our study offer insight into the distribution of spermatogenesis in men with cryptozoospermia and NOA.

Use of testicular sperm in couples with SCSA-defined high sperm DNA fragmentation and failed intracytoplasmic sperm injection using ejaculated sperm.

Sperm DNA fragmentation (SDF) has been linked with male infertility, and previous studies suggest that SDF can have negative influence on pregnancy outcomes with assisted reproduction. We performed a retrospective review of consecutive couples with a high SDF level that had intracytoplasmic sperm injection (ICSI) using testicular sperm (T-ICSI). We compared the T-ICSI outcomes to that of two control groups: 87 couples with failed first ICSI cycle and who had a second ICSI cycle using ejaculated sperm (Ej-ICSI), and 48 consecutive couples with high sperm chromatin structure assay (SCSA)-defined SDF (>15%) that underwent an ICSI cycle using ejaculated sperm after one or more failed ICSI cycles (Ej-ICSI-high SDF). The mean number of oocytes that were retrieved and the total number of embryos were not different among the three groups. The mean number of transferred embryos in the T-ICSI group was higher than the Ej-ICSI group but not significantly different than the Ej-ICSI-high SDF group (1.4, 1.2, and 1.3, respectively, P < 0.05). Clinical pregnancy rate in the T-ICSI group was not significantly different than the Ej-ICSI and Ej-ICSI-high SDF groups (48.6%, 48.2%, and 38.7%, respectively, P > 0.05). No significant difference was found in live birth rate when comparing T-ICSI to Ej-ICSI and Ej-ICSI-high SDF groups. The results suggest that pregnancy outcomes and live birth rates with T-ICSI are not significantly superior to Ej-ICSI in patients with an elevated SCSA-defined sperm DNA fragmentation and prior ICSI failure(s).

Evaluation of Oral Pentoxifylline, Colchicine, and Penile Traction for the Management of Peyronie's Disease.

INTRODUCTION: Currently, there are several treatment options for Peyronie disease (PD). Although surgical interventions have better reported outcomes than conservative therapy, surgery is not suitable for all patients with PD. Therefore, oral therapy for PD is still a frequently used treatment due to low cost, convenience and limited side effects. However, current literature on the efficacy of oral therapy in PD is inconclusive. Pentoxifylline and colchicine have both shown some promise though further studies are required to confirm their effectiveness. AIM: The aim of this study was to assess the efficacy of oral therapy for PD, including pentoxifylline and colchicine, coupled with the Andropenis penile traction therapy (PTT) extender on degree of penile curvature and plaque size. METHODS: Between March 2015 and June 2018, a prospectively collected database for patients receiving oral therapy for PD (pentoxifylline and/or colchicine) was reviewed. MAIN OUTCOME MEASURE: Collected data variables were compared at baseline and after 6 months of treatment, including degree of curvature, plaque size, and penile Doppler ultrasound parameters (peak systolic velocity, minimum diastolic velocity, and pulsatility index). PTT was applied by the patient for a total of 1 hour per day for 6 months. RESULTS: A total of 46 patients were involved in this study. Mean age was 56 ± 10 years. There was a significant decrease in the degree of penile curvature after 6 months (55.8º ± 20º vs 41.4º ± 20.8º; P = .03). Likewise, the plaque size decreased significantly from 5.42 ± 2.7 to 2.42 ± 1.71 cm2; P = .0001. There was a significant increase in the peak systolic velocity from 29.8 ± 10.02 to 38.2 ± 11cm/sec; P = .02, whereas no statistically significant difference could be detected regarding end diastolic velocity (M = 0.56 ± 3.1 vs 1.59; P = .415) or pulsatility index (Mdiff = 0.03; CI = -0.06 to 0.12; P = .473). Furthermore, there was no statistically significant difference in medication type of pentoxifylline or colchicine (Mdiff = 17.23; CI = -3.31 to 37.77; P = .09). CONCLUSION: Altogether, pentoxifylline and colchicine, taken with concomitant PTT, present a potentially convenient, low cost, and effective treatment for penile curvature and plaque resulting from PD. Prospective randomized trials are still required for better evaluation of the course of PD with patients undergoing conservative management. Ibrahim A, Gazzard L, Alharbi M, et al. Evaluation of Oral Pentoxifylline, Colchicine, and Penile Traction for the Management of Peyronie's Disease. Sex Med 2019;7:459-463.

Is there a role for varicocelectomy after microdissection testicular sperm extraction? Case report and literature review.

Men with non-obstructive azoospermia (NOA) are candidates for microdissection testicular sperm extraction (microTESE). In men with NOA and varicocele, varicocelectomy has been associated with the appearance of sperm in the ejaculate. We report an infertile male with NOA, a solitary left testicle and a left clinical varicocele. The patient first underwent an extensive left microTESE. No spermatozoa were seen on initial microscopic evaluation but after an extensive search, spermatozoa were identified. ICSI did not result in pregnancy. Fifteen months after the microTESE, the patient underwent a left microsurgical varicocelectomy. A semen analysis post-varicocelectomy revealed the presence of sperm.

18 Years of Holmium Laser Enucleation of the Prostate: A Single Center Experience.

PURPOSE: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. MATERIALS AND METHODS: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. RESULTS: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.

Miniature antenna for sensor network on human head.

This paper proposes a novel miniaturized antenna for sensor network with focus on placement on human head. The antenna is within the volume of 3.5×3.5×1.5 mm(3). It provides directive gain in the direction outward the body.

Urinary incontinence: prevalence, risk factors, and impact on health related quality of life in Saudi women.

AIMS: The aims of this study were to determine the prevalence, risk factors, and impact upon health related quality of life (HRQL) of urinary incontinence in Saudi women. METHODS: We performed a clinic-based cross-sectional survey. 6,600 women aged 20 years and older were selected. The bother of urinary incontinence symptoms was assessed using the Arabic version of the short form of Urogenital Distress Inventory (UDI-6) questionnaire. We measured the impact of urinary incontinence on HRQL using the Incontinence Impact Questionnaire (IIQ-7). RESULTS: The overall prevalence of urinary incontinence in our study was 29%. The prevalence of urinary incontinence according to its type was 50% stress urinary incontinence, 28% urgency urinary incontinence, and 22% mixed urinary incontinence. Older age, obesity, large baby birth weight, high parity, caesarean delivery, vaginal delivery, and diabetes were significant risk factors. Less than 10% of the women in this study reported a significant effect of urinary incontinence on their HRQL. In our study population, 9% sought medical care. CONCLUSIONS: Twenty-nine percent of the women in Riyadh suffered from urinary incontinence. Diabetes is the most significant factor. Urinary incontinence affects women's HRQL. Most of the women did not seek medical care. We consider our study as an important step to start the plans for early detection, and treating urinary incontinence in Saudi Arabia.