5HT-1A receptor polymorphism effects ejaculatory function in Egyptian patients with lifelong premature ejaculation / Efectos del polimorfismo del gen del receptor de 5-HT1A en la función eyaculatoria de pacientes egipcios con eyaculación precoz permanente

INTRODUCTION AND OBJECTIVES: Lifelong premature ejaculation (LPE) is identified as the inability to delay ejaculation for more than 1min after vaginal penetration occurring on all or almost all sexual experiences together with feelings of frustration of both the patient and his partner with avoidance of sexual intimacy. Recently, a role for (HTR1A)-C (1019) G gene polymorphism in patients with LPE was postulated. MATERIALS AND METHODS: Three hundred and fifty participants were prospectively enrolled in this study. They were recruited from the outpatient clinic of Andrology & STDs Department Cairo University from December 2015 to January 2017. Two hundred and forty-five of them were suffering from lifelong premature ejaculation joined this study, in addition to 105 controls. We instructed the wives of the patients to measure the intra-vaginal ejaculation latency time (IELT) of the first intercourse only using a stopwatch for 1 month. Genotyping was performed at the end of the study. RESULTS: The results showed that the majority of the patients were CG, while; the controls were GG. This difference revealed a statistically significant association (p-value<0.001). A highly significant statistical association was found between the studied gene polymorphisms and the IELT among cases (p-values=0.001). CONCLUSION: The study replicated the potential role of 5HT-1A receptor gene polymorphisms in patients with lifelong premature ejaculation

INTRODUCCIÓN Y OBJETIVOS: La eyaculación precoz permanente (LPE) se identifica como la incapacidad para retrasar la eyaculación más de 1min después de la penetración vaginal, que en todas o casi todas las experiencias sexuales provoca sentimientos de frustración tanto en el paciente como en su pareja y conduce a la abstención de las relaciones sexuales. Recientemente, se ha propuesto que el polimorfismo del gen (HTR1A)-C (1019) G tiene un papel en pacientes con LPE. MATERIALES Y MÉTODOS: Se incluyó a 350 participantes en este estudio. Se los reclutó en la clínica ambulatoria del Departamento de Andrología y ETS de la Universidad del Cairo entre diciembre de 2015 y enero de 2017. Doscientos cuarenta y cinco de ellos con eyaculación precoz permanente se incorporaron a este estudio, además de 105 controles. Instruimos a las esposas de los pacientes para medir el tiempo de latencia de la eyaculación (TLE) intravaginal de la primera relación sexual utilizando solamente un cronómetro durante 1 mes. La genotipificación se realizó al final del estudio. RESULTADOS: Los resultados mostraron que la mayoría de los pacientes fueron CG, mientras los controles fueron GG. Esta diferencia reveló una asociación estadísticamente significativa (valor de p < 0,001). Se encontró una asociación estadística muy significativa entre los polimorfismos de los genes estudiados y el TLE entre casos (valores de p = 0,001). CONCLUSIÓN: El estudio reprodujo el papel potencial de los polimorfismos del gen del receptor de 5-HT1A en pacientes con eyaculación precoz permanente

The application of spontaneous corpus cavernosum EMG to assess the status of cavernous smooth muscles, a preliminary study / La aplicación de cuerpo cavernoso EMG espontáneo para evaluar el estado de los músculos lisos cavernosos. Un estudio preliminar

Introduction: Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. Objective: To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methods: Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. Results: According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials' amplitudes ranged 223-320, 179-237, 103-250 and 83-200μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200-250μV that exceeded/approached the lowest value recorded from men in group 2. Conclusion: CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions

Introducción: Las pruebas diagnósticas para la disfunción eréctil (DE) vascular dependen de la relajación de los músculos cavernosos lisos (MCL) después de una inyección intracorporal (IIC). El tono simpático mejorado, que es frecuente durante la realización de estas pruebas, puede sesgar los resultados. Además, las enfermedades de los MCL pueden provocar DE con enfermedades venooclusivas (EVO). Las amplitudes de los potenciales de la electromiografía de los cuerpos cavernosos (CC-EMG) representan la actividad simpática integrada de los MCL sanos. Las células madre y la terapia génica son opciones terapéuticas potenciales para los MCL con discapacidad. Objetivo: Utilizar CC-EMG como una nueva técnica de diagnóstico que pueda confirmar la integridad de los MCL e identificar a los pacientes con actividad de MCL deteriorada entre los diagnosticados con DE vascular por ecografía Doppler color dúplex (CDDU, por sus siglas en inglés). Paciente y métodos: El grupo 1 incluyó a 24 pacientes con DE con una respuesta negativa a la IIC. El grupo 2 incluía a 10 varones sin DE. En los pacientes incluidos en el grupo 1 se realizó CDDU en el pene y todos los participantes presentaron grabaciones de la CC-EMG espontáneas. Resultados: De acuerdo con los parámetros CDDU, el grupo 1 se dividió en subgrupos, como 9 arteriales, 10 VOD y 5 tipos mixtos. Las amplitudes de los potenciales de la CC-EMG variaron entre 223-320, 179-237, 103-250 y 83-200μV para el grupo 2 y los subgrupos arteriales, mixtos y VOD, respectivamente. Los amplios rangos de amplitudes de los potenciales se registraron en los subgrupos de pacientes con un elemento de VOD. Cuatro pacientes dentro de estos subgrupos tenían amplitudes de potencial de la CC-EMG de 200-250μV que excedían/acercaban el valor más bajo para varones en el grupo 2. Conclusión: Las grabaciones de la CC-EMG provocaron marcadas diferencias de actividad de los MCL entre los pacientes diagnosticados con un elemento de VOD DE por CDDU. Este hallazgo destacó la necesidad de utilizar CC-EMG para evaluar la integridad de los MCL. La identificación de pacientes con actividad de CSM afectada puede modificar los métodos elegidos para las intervenciones terapéuticas

5HT-1A receptor polymorphism effects ejaculatory function in Egyptian patients with lifelong premature ejaculation.

INTRODUCTION AND OBJECTIVES: Lifelong premature ejaculation (LPE) is identified as the inability to delay ejaculation for more than 1min after vaginal penetration occurring on all or almost all sexual experiences together with feelings of frustration of both the patient and his partner with avoidance of sexual intimacy. Recently, a role for (HTR1A)-C (1019) G gene polymorphism in patients with LPE was postulated. MATERIALS AND METHODS: Three hundred and fifty participants were prospectively enrolled in this study. They were recruited from the outpatient clinic of Andrology & STDs Department Cairo University from December 2015 to January 2017. Two hundred and forty-five of them were suffering from lifelong premature ejaculation joined this study, in addition to 105 controls. We instructed the wives of the patients to measure the intra-vaginal ejaculation latency time (IELT) of the first intercourse only using a stopwatch for 1 month. Genotyping was performed at the end of the study. RESULTS: The results showed that the majority of the patients were CG, while; the controls were GG. This difference revealed a statistically significant association (p-value<0.001). A highly significant statistical association was found between the studied gene polymorphisms and the IELT among cases (p-values=0.001). CONCLUSION: The study replicated the potential role of 5HT-1A receptor gene polymorphisms in patients with lifelong premature ejaculation.

Prospective Analysis on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Semen Parameters in Males with Unexplained Infertility.

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.

Pilot Study on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Erectile Function in Aging Males With Partial Androgen Deficiency (PADAM).

This study was conducted on 30 consecutive male patients presenting to Kasr-Al Ainy Andrology outpatient clinic complaining of manifestations of partial androgen deficiency in aging males (PADAM). In this study (750 mg/day) of Tribulus terrestris in 3 divided doses, each of 250 mg, as an endogenous testosterone enhancer had been tried for a duration of 3 months and the evaluation of its effect had been monitored for each patient concerning its effect on serum testosterone (total and free) and luteinizing hormone (LH), as well as its impact on erectile function, which was evaluated by the International Index of Erectile Function-5 (IIEF-5) questionnaire for those patients. Results showed a statistically significant difference in the level of testosterone (total and free) and IIEF-5, but no statistically significant difference in the level of LH before and after treatment. Also, the study showed statistically significant correlation between testosterone (total and free) and IIEF-5, but no statistically significant correlation between the level of LH and the IIEF-5 before and after treatment.

Correlation between the European System for Cardiac Operative Risk Evaluation and sexual function after coronary artery bypass graft surgery.

INTRODUCTION: The published studies discussing the prognostic factors for expected sexual function after coronary artery bypass graft (CABG) are still limited. AIM: Examining the correlation between the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the abridged form of International Index of Erectile Function questionnaire (IIEF-5), as a quick and inexpensive tool for the cardiologist to predict the sexual function after CABG. MAIN OUTCOME MEASURES: Validated standardized questionnaire commonly used by cardiologists in identifying appropriate weight to various risk factors related to adult cardiac operations. METHODS: Preoperatively patients were evaluated as regards to the sexual function by (IIEF-5) and pharmaco-penile duplex ultrasound. Moreover all patients were evaluated bu EuroSCORE. Six months after surgery, the erectile function of all patients was revaluated according to the same preoperative procedures. The patients were categorized with EuroSCORE as follows: The low-risk group (EuroSCORE 0­2), the medium-risk group (EuroSCORE 3­5), and the high-risk group (EuroSCORE 6 plus). RESULTS: The EuroSCORE was negatively correlated with the IIEF-5 score (r = -0.224, P = 0.025 or rs = -0.259, P = 0.009). Moreover, low-risk patients had significantly higher IIEF-5 scores compared with medium-risk patients (mean standard deviation = 15.27 6.03 vs. 12.18 6.07, P < 0.05). CONCLUSIONS: There is an inverse correlation between the components of EuroSCORE and the IIEF-5 score. Patients with higher EuroSCORE had lower IIEF-5 scores and vice versa. The EuroSCORE is a useful, quick, and inexpensive tool that allows prediction of ED in those patients with coronary artery disease patients who are undergoing CABG.

Vascular risk factors as predictors of sexual function following coronary artery bypass graft.

INTRODUCTION: A strong association between cardiovascular risk factors and erectile dysfunction (ED) was suggested. Coronary artery bypass grafting (CABG) is the gold standard for surgical myocardial revascularization. AIM: We herein evaluate the impact of vascular risk factors on postoperative sexual functions in patients undergo CABG. MAIN OUTCOME MEASURES: ED severity by the International Index of Erectile Function (IIEF-5) and penile duplex study. METHODS: The present study included 100 patients who underwent CABG. The patients were evaluated by an abridged form of the IIEF-5 questionnaire, followed by CABG. Six months after surgery the erectile function of all patients was re-evaluated utilizing the IIEF-5. RESULTS: Number of risk factors was significantly associated with postoperative change in IIEF-5 score (P = 0.02). A post hoc analysis of the association revealed that patients with one risk factor were significantly more likely to have increased IIEF-5 scores (N = 18), whereas those with two or more risk factors were significantly more likely to have decreased IIEF-5 scores (N = 21, P < 0.05). Furthermore, those with no risk factors were significantly more likely to be stable (N = 8) compared with those with more than two risk factors, who were more likely to have decreased scores (P < 0.05). The hierarchical logistic regression results showed that when examining all risk factors simultaneously, because of multicollinearity, only hyperlipidemia was significantly associated with postoperative ED (odds ratio [OR] = 11.33, confidence interval [CI] = 1.25, 102.82). Frequency of intercourse was also significantly associated with postoperative ED after controlling for risk factors (OR = 0.71, CI = 0.52, 0.97). CONCLUSIONS: This data clearly shows that the number of cardiovascular risk factors is an essential predictive factor for sexual function following surgery. Only hyperlipidemia may play a predictive role for the future sexual function of patients undergo CABG.

The impact of on-pump coronary artery bypass surgery vs. off-pump coronary artery bypass surgery on sexual function.

INTRODUCTION: Erectile dysfunction and ischemic heart disease are common health problems that affect elderly individuals. Despite advances in treatment strategies, cardiopulmonary bypass (CPB) has been used for coronary artery bypass grafting (CABG) for over three decades for surgical myocardial revascularization. AIM: To discuss the difference between the on pump and the newer alternative-the off-pump CABG (OPCABG) surgery-on the sexual function. METHODS: This prospective study included 100 patients who underwent CABG. MAIN OUTCOME MEASURES: The patients were evaluated by an abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound and finally by the European System for Cardiac Operative Risk Evaluation. The patients were underwent either on-pump CABG or OPCABG. Six months after surgery, the erectile function was revaluated according to the same preoperative measures. RESULTS: Patients included in the study were classified into two matched groups: group I-patients who underwent on-pump CABG (N = 50); and group II-patients who underwent OPCABG (N = 50). The frequency of intercourse was significantly higher in OPCABG (P < 0.05) after surgery. The mean +/- standard deviation of the IIEF-5 scores of the on-pump group postoperatively became 12.48 +/- 7.19 whereas it became 15.88 +/- 6.67 in the off-pump group (P < 0.05). Moreover, the number of patients who reported postoperative improvement of their IIEF-5 score was significantly higher in OPCABG group (N = 23) compared with the conventional on-pump CABG group (N = 13) (P < 0.05). There was no significant change in the duplex ultrasound after surgery between both groups. CONCLUSIONS: The OPCABG has a diminished impact on the sexual function of patients compared with the conventional on-pump CABG. Therefore, the type of operation can be considered a predictive factor of sexual function following CAB surgery.