Estimation of B-inhibin and anti mullerian hormone in functional azoospermia and their correlations with surgical sperm retrieval: A prospective case-control study.

OBJECTIVES: The current study estimated the levels of anti mullerian hormone (AMH) and inhibin-B and reproductive hormones in non obstructive azoospermic (NOA) cases and obstructive azoospermic (OA) cases as well as comparing between them as regards the sensitivity and specificity in determining the sperm retrieval hope in the NOA cases. Finally, we analyzed any potential correlation between all the hormones measured in the current study. METHODS: The current case control study was conducted at the andrology outpatient clinic from June (2021) to March (2022). The study recruited 135 participants divided equally into three groups NOA cases, OA cases and controls, respectively. RESULTS: The mean inhibin-B was significantly lower in the NOA cases compared to the OA cases and the controls. There was a positive moderate correlation between AMH and Inhibin-B. Also, there was a positive moderate correlation between inhibin-B and free testosterone (FT) and positive weak correlation between beta Inhibin and leutinizing hormone (LH). CONCLUSIONS: The current study asserts the observation that inhibin-B is also expressed by Leydig cells as it has demonstrated positive correlations with FT and LH.

Evaluation of the effect of cervical and lumbar disc herniations on female sexual function: a comparative prospective study.

PURPOSE: We aimed to evaluate the effect of cervical disc herniation (CDH) and lumbar disc herniation (LDH) on female sexual functioning before and after surgical intervention. METHODS: The current study was conducted from February 2022 to February 2023. A total of 100 sexually active female patients in their reproductive phase who were diagnosed with CDH and LDH based on physical examination and previous magnetic resonance imaging (MRI) results, as well as 50 healthy females, were enrolled. The female subjects were evaluated using the validated Arabic version of the female sexual function index (ArFSFI), a 0 to 10 visual analogue scale (VAS), the Oswestry disability index (ODI) and Beck's depression index (BDI). RESULTS: The baseline ArFSFI domains and total scores were greatest in the controls, followed by the CDH group. The ArFSFI domains and total scores were greatest in the control group, followed by the postoperative ArFSFI domains and total scores in the cervical group. The variations in satisfaction, pain, and overall ArFSFI ratings were significant across research groups. The difference in desire, arousal, lubrication, and orgasm was substantial in the lumbosacral group, but there were no significant changes between the cervical and control groups. Postoperatively, ArFSFI domains and overall scores improved in both of the cervical and lumbar groups. Both research groups' ODI score and grade improved after surgery. Finally, both groups' BDI score and grade improved after surgery. CONCLUSION: Female sexual dysfunctions caused by CDH and LDH improved considerably after surgery.

Role of penile rehabilitation through daily intake of 5 mg tadalafil on erectile dysfunction after different presentations of penile fracture: a prospective case-control study.

PURPOSE: We aimed in the current study to identify the predictive factors of ED occurrence in healthy individuals following penile fracture surgical repair as well as the effect of penile rehabilitation in the form of daily tadalafil 5 mg intake for 1 month for patients who suffered from ED after penile fracture incident. METHOD: The current study was a prospective case-control study. Twenty-five patients were enrolled into the study starting from January (2022) to February (2023). Furthermore, time of presentation was determined, and length of tear intra-operative was measured, and then, a follow-up 1 week postoperatively in the outpatient clinic was conducted. All patients were instructed to start intercourse at least 2 weeks after the first visit provided that the wound epithelialized. Potent patients returned back home. A rehabilitation course of daily tadalafil 5 mg for 1 month was prescribed for patients who started complaining of ED that was confirmed by evaluation with the Arabic validated version of the international index of erectile function (ArIIEF-5). The rehabilitation therapy was terminated by resumption of normal erectile function. Thus, re-evaluation with the ArIIEF-5 was determined according to their response to therapy. Also, the patients were evaluated by hospital anxiety and depression scale (HADS) before and after penile fracture repair. RESULTS: The current study had demonstrated that a 1% increase in age determines an increase in odds ratio for post-penile fracture ED with 73.6% and 1 cm increase in the length of tear determines an increase in odds ratio for post-penile fracture ED with 20.04 times. CONCLUSION: The current study enhances the proper counseling of these patients prior to repairing the defect about the probability of ED occurrence as well as initiating early penile rehabilitation to help these patients resuming their normal sexual activity as soon as possible.

Seminal L-Carnitine In Infertile Oligoasthenoteratozoospermic Men with Varicocele.

Background: Few studies have investigated the relationship of seminal L-Carnitine (LC) with male infertility associated with varicocele. The purpose of this prospective cross-sectional study was to assess seminal plasma LC levels in infertile oligoathenoteratozoospermic (OAT) men with varicocele. Methods: Overall, 86 men were investigated. They were divided into infertile OAT men with varicocele (n=45), infertile OAT men without varicocele (n=21), and fertile men (n=20) as a control group. According to WHO guidelines, these men were subjected to history taking, clinical examination, and semen analysis. Seminal LC levels were evaluated by the colorimetric method. Statistical comparisons were done using Kruskal-Wallis and Mann-Whitney U tests and correlations were verified by the Pearson test. P-value<0.05 was set to be statistically significant. Results: The mean seminal plasma LC levels were significantly lower in infertile OAT men with varicocele (216.3±57.1 ng/ml) compared to infertile OAT men without varicocele (252.9±62.9 ng/ml, p=0.01), or fertile men (382.8±63.6 ng/ml, p=0.001). Besides, the mean seminal plasma LC level exhibited statistically significant decreases in infertile OAT men of varicocele grade III compared to varicocele grade II cases, and in infertile OAT men with bilateral varicocele compared with unilateral varicocele cases. Collectively, there was a statistically significant positive correlation between seminal LC levels with sperm concentration, motility, and normal morphology. Conclusion: Seminal LC levels are expressively reduced in infertile OAT men with varicocele and are influenced by an increase in varicocele grade and laterality.

Assessment of seminal calcium and magnesium levels in infertile men with varicocele before and after varicocelectomy.

BACKGROUND: Trace elements perform a vital role in all stages of human physiology, as well as reproduction. OBJECTIVE: This study aimed to assess seminal calcium (Ca) and magnesium (Mg) in infertile men associated with varicocele (Vx). MATERIALS AND METHODS: Overall, 50 men were divided into two groups: fertile men (n = 20) and infertile men who were scheduled for Vx surgical repair (n = 30). Exclusion criteria were as follows: azoospermia, smoking, leukocytospermia, and consumption of Ca and/or Mg supplements. All cases were subjected to history taking and clinical examination. Semen analysis and assessment of seminal Ca and Mg by the colorimetric method were carried out for all cases at the base point and 3 months postvaricocelectomy. RESULTS: Generally, the mean seminal Ca and Mg levels demonstrated significant decreases in infertile men with Vx compared with the healthy fertile men linked to higher Vx grade as well as Vx bilaterality. These seminal decreases demonstrated significant increases after Vx surgical repair. Collectively, seminal Ca and Mg levels showed a significant positive correlation (r = 0.665, p= 0.001). Besides, seminal Ca, Mg levels, and Ca/Mg ratio showed significant positive correlation with sperm concentration (r = 0.479, p = 0.001; r = 0.541, p = 0.001; r = 0.282, p = 0.001, respectively), sperm motility percentage (r = 0.493, p = 0.001; r = 0.477, p = 0.001; r = 0.353, P = 0.001, respectively), and sperm normal forms percentage (r = 0.578, p = 0.001; r = 0.520, p = 0.001; r = 0.430, p = 0.001, respectively). DISCUSSION AND CONCLUSION: Seminal Ca and Mg levels and Ca/Mg ratio are significantly decreased in infertile men associated with Vx compared with fertile men with significant increases after varicocelectomy.

Seminal SIRT1-oxidative stress relationship in infertile oligoasthenoteratozoospermic men with varicocele after its surgical repair.

This work assessed seminal SIRT1-oxidative stress (OS) relationship in infertile oligoasthenoteratozoospermic (OAT) men after varicocele repair. Overall, thirty OAT men with varicocele were investigated. Inclusion criteria were infertile males (males who were unable to initiate a pregnancy within 1 year of regular unprotected intercourse), confirmed OAT and normal female factor. These cases were subjected to history taking, clinical checkup and semen analysis. In their semen, seminal SIRT1, malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were assessed. These men were subjected to varicocele surgical repair and were followed up for 3 months. Post-operatively, the mean seminal SIRT1, GPx levels showed significant increases and the mean MDA level showed significant decrease compared to the pre-operative levels linked to improved sperm parameters. The mean seminal SIRT1, GPx, MDA levels showed more significant improvement in grade III varicocele cases compared to grade II cases after surgical repair. Seminal SIRT1 levels showed significant positive correlations with sperm concentration, sperm motility, sperm normal morphology, seminal GPx levels and a significant negative correlation with seminal MDA levels. It could be concluded that seminal SIRT1 is significantly decreased in infertile OAT men with varicocele after its surgical repair linked to improved sperm parameters as well as seminal OS.

Cavernosal hydrogen sulfide levels are associated with nitric oxide and hemeoxygenase levels in diabetic rats.

Penile erection is a neuromuscular event modulated by psyche, hormones as well as neurotransmitters. This pre-clinical study aimed to assess hydrogen sulfide (H2S) relationship with nitric oxide (NO) and hemeoxygenase (HO) in the cavernous tissues of diabetic rats. Overall, 90 adult male rats were investigated (6 groups, n = 15 each). They were subdivided into the following groups; untreated rats, rats treated with H2S donor/inhibitor, induced diabetic rats, diabetic rats treated with H2S donor/inhibitor. At the 6th week, the rats were killed to assess cavernous tissue cGMP, NO, H2S, HO enzyme activity levels. The rats treated with H2S donor showed increased mean cavernous tissue cGMP, NO, H2S, and HO enzyme activity levels whereas induced diabetic rats and rats treated with H2S inhibitor showed significant decreases in these parameters compared with the untreated rats. On the other hands, diabetic rats treated with H2S donor showed elevated mean cavernous tissue cGMP, NO, H2S, and HO enzyme activity levels whereas diabetic rats treated with H2S inhibitor showed significant decreases in these parameters compared with diabetic rats. Cavernous tissue H2S levels exhibited significant positive correlations with the cavernous tissue levels cGMP, NO, and HO enzyme activity levels. From these results, it could be concluded that cavernous tissues H2S plays a role of male sexual health by affecting cavernous tissues NO and HO enzyme activity in general and in diabetics in particular.

Serum L-carnitine and vitamin D levels may be low among oral sildenafil citrate non-responders.

This cross-sectional comparative study aimed to compare serum L-carnitine and 25(OH)D levels between men with ED non-responding for oral sildenafil citrate and healthy volunteers. Overall, 192 men, recruited from two University Hospitals, were allocated into two equal groups of matched age; healthy potent men and men with ED non-responders for oral sildenafil citrate. Oral sildenafil citrate non-responders self-reported inadequate erectile responses after four attempts using 100 mg with the manufacturer's guidelines relative to meals, associated medications, and sexual stimulation/arousal. Exclusion criteria were: diabetes, cardiovascular disorders, beta blockers treatment, morbid obesity, thyroid disorders, post-radical prostatectomy, and hepatic/renal failure. All participants were subjected to; history taking, clinical examination, validated IIEF-5 questionnaire, estimation of serum L-carnitine by calorimetric method and serum 25(OH)D by ELISA method. Compared with potent controls, ED men non-responders for oral sildenafil citrate showed significant decreases in the mean serum L-carnitine level (16.8 ± 3.6 uM/L versus 66.3 ± 11.9 uM/L, P = 0.001), the mean serum 25(OH)D level (21.2 ± 7.1 ng/ml versus 54.6 ± 7.9 ng/mL, P = 0.001) and IIEF-5 score (7.8 ± 2.6 versus 23.9 ± 1.3). Serum L-carnitine showed significant positive correlation with IIEF-5 scores (r = 0.873, P = 001), serum 25(OH)D (r = 0.796, P = 0.001) and significant negative correlation with the age (r = -0.515, P = 0.001). Serum 25(OH)D showed significant positive correlation with IIEF-5 scores (r = 0.855, P = 0.001) and significant negative correlation with the age (r = -0.223, P = 0.005). It is concluded that normal homeostasis of serum L-carnitine and 25(OH)D play a role in male sexual health being significantly decreased in ED non-responding for oral sildenafil citrate.

Aryl hydrocarbon receptor (AhR) rs2066853 gene polymorphism association with infertile oligoasthenoteratozoospermic men and seminal oxidative stress.

This study aimed to assess the association between aryl hydrocarbon receptor (AhR) rs2066853 gene polymorphism with infertile oligoasthenoteratozoospermic (OAT) men and seminal oxidative stress (OS). A total of 170 Egyptian men were allocated according to their semen analysis into fertile normozoospermic controls (n = 50) and infertile OAT men (n = 120). They were subjected to history taking, clinical examination, semen analysis, estimation of seminal glutathione peroxidase (GPx), and malondialdehyde (MDA). AhR rs2066853 gene polymorphism was identified in the blood by PCR-RFLP. Comparing infertile OAT men with fertile controls, AhR rs2066853 genotypes showed decreased prevalence for wild homozygous genotype GG (35.8 vs 56%) and for heterozygous genotype GA (17.5 vs 30%) and an increased prevalence for homozygous genotype AA (46.7 vs 14%). Distribution of alleles of AhR rs2066853 among OAT men compared with fertile men showed decreased prevalence of G allele (44.6 vs 71%) and an increased prevalence of A allele (55.4 vs 29%). Seminal MDA demonstrated significant increase whereas seminal GPx demonstrated significant decrease in cases with AA and GA/AA genotypes compared to cases with GG genotype. It is concluded that there is a significant association between AhR rs2066853 genotype polymorphism with decreased sperm parameters as well as increased seminal oxidative stress in infertile OAT men.

Seminal miRNA Relationship with Apoptotic Markers and Oxidative Stress in Infertile Men with Varicocele.

Aim. This study aimed to assess seminal miRNA relationship with seminal apoptotic markers and oxidative stress (OS) in infertile men associated with varicocele (Vx). Methods. In all, 220 subjects were divided into the following groups: fertile normozoospermic men, fertile normozoospermic men with Vx, infertile oligoasthenoteratozoospermic (OAT) men without Vx, and infertile OAT men with Vx. They were subjected to history taking, clinical examination, and semen analysis. In their semen, the following were estimated: miRNA-122, miRNA-181a, and miRNA-34c5 using quantitative real-time PCR, apoptotic markers (BAX, BCL2) protein expression, and OS markers [malondialdehyde (MDA) and glutathione peroxidase (GPx)]. Results. The mean levels of seminal miRNA-122, miRNA-181a, and miRNA-34c5 were significantly reduced in infertile OAT men with Vx compared with other groups coupled with Vx grade and Vx bilaterality. Seminal miRNA-122, miRNA-181a, and miRNA-34c5 were positively correlated with sperm concentration, total sperm motility, sperm normal morphology, seminal GPx, and seminal BCL2 and negatively correlated with seminal MDA and seminal BAX. Conclusions. Seminal miRNA-122, miRNA-181a, and miRNA-34c5 are decreased in infertile OAT men with Vx associated with increased Vx grade and Vx bilaterality. In addition, they are positively correlated with sperm parameters and negatively correlated with OS, apoptotic markers.

Endothelial nitric oxide synthase gene polymorphism relationship with semen parameters and oxidative stress in infertile oligoasthenoteratozoospermic men.

OBJECTIVE: To assess endothelial nitric oxide synthase (eNOS) gene polymorphism relationship with semen parameters and oxidative stress in infertile oligoasthenoteratozoospermic (OAT) men. MATERIALS AND METHODS: Three hundred subjects were divided into healthy fertile men (n = 80) and infertile OAT men (n = 220). They were subjected to history taking, clinical examination, and semen analysis in addition to malondialdehyde and glutathione peroxidase estimation in seminal plasma. Polymorphisms of eNOS G894T and T786C genotypes in peripheral blood were identified by the polymerase chain reaction-restriction fragment length polymorphism analysis. RESULTS: Comparing infertile OAT men with fertile controls, eNOS genotype G894T demonstrated prevalence of 36.8% vs 50% for wild type (GG), 35.0% vs 47.5% for heterozygous type (GT), and 28.2% vs 2.5% for mutant homozygous type (TT). Compared with GG homozygotes, carriers with A allele exhibited >1.716-fold increased risk of OAT occurrence. Comparing infertile OAT men with fertile controls, eNOS genotype T786C demonstrated prevalence of 37.3% vs 51.3% for wild type (TT), 32.7% vs 45% for heterozygous type (TC), and 30% vs 3.7% for mutant type (CC) with significant differences. Compared with TT homozygotes, carriers with C allele exhibited >1.769-fold increased risk of OAT occurrence. G894T and T786C genotypes demonstrated significant negative correlation with sperm count, total sperm motility, sperm normal forms, and seminal glutathione peroxidase, and significant positive correlation with seminal malondialdehyde. G894T genotype demonstrated significant positive correlation with T786C genotype. CONCLUSION: There is a significant relationship between eNOS genotypes T786C, G894T polymorphisms with decreased sperm parameters and increased seminal oxidative stress.

Seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele.

OBJECTIVE: To assess seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele (Vx). MATERIALS AND METHODS: A total of 111 men were investigated and divided into the following groups: healthy fertile men (n = 20), fertile men with Vx (n = 16), infertile oligoasthenoteratozoospermic men without Vx (n = 29), and infertile oligoasthenoteratozoospermic men with Vx (n = 46). They were subjected to history taking, clinical examination, and semen analysis. In their seminal plasma, BAX and BCL2 gene and protein expressions were estimated. RESULTS: The mean level of seminal BAX gene and protein was significantly decreased, and the mean level of seminal BCL2 gene and protein was significantly increased in fertile men compared with fertile men with Vx and in infertile men without Vx compared with infertile men with Vx. The mean level of seminal BAX gene and protein were significantly increased in men associated with bilateral Vx compared with men associated with unilateral Vx and in cases with Vx grade III compared with Vx grade I and II cases. Seminal BAX demonstrated significant negative correlation with sperm concentration, sperm motility, and sperm normal forms. Seminal BCL2 demonstrated significant positive correlation with sperm concentration, sperm motility, and sperm normal forms and significant negative correlation with seminal BAX. CONCLUSION: Seminal BAX is significantly increased and seminal BCL2 is significantly decreased in men associated with Vx. Seminal BAX is significantly increased in men associated with bilateral Vx compared with unilateral Vx and in cases with Vx grade III compared with Vx grade I and II cases. Seminal BAX demonstrates significant negative correlation with sperm concentration, sperm motility, and sperm normal forms, whereas seminal BCL2 demonstrates significant reverse positive correlations.

Evaluation of surgical outcome of penile augmentation and lengthening procedures.

Our study included 280 patients complaining of small-sized penis. They were seen in the outpatient clinic of the Andrology Department, Kasr El Aini, Cairo University. Patients were collected from 2002 till 2008 and classified into 4 categories from an etiological point of view. Eleven patients (3.9%) were operated upon according to fine selection criteria; six patients were selected for lengthening procedures, while two patients were selected for increasing girth procedures and three patients for combined operation of lengthening and increasing girth techniques. Seven patients showed subjective satisfaction after lengthening procedures and four patients showed subjective satisfaction after increasing girth techniques. In conclusion, detailed analysis of short penis complaint with a proper diagnosis and patient education are required for accurate management of patients complaining of a short penis.