A 6-month, prospective, observational study of PDE5 inhibitor treatment persistence and adherence in Middle Eastern and North African men with erectile dysfunction

BACKGROUND

Erectile dysfunction (ED) negatively impacts quality of life. Phosphodiesterase type 5 inhibitors (PDE5Is) are effective in treating ED; however, rates of discontinuation remain high.

OBJECTIVES

To assess on-demand PDE5I treatment persistence and adherence through 6 months in Middle Eastern and North African (MENA) men with ED in a prospective, non-interventional, observational trial.

RESEARCH DESIGN AND METHODS

Enrolled men were ≥18 years old from Saudi Arabia, Egypt, and the United Arab Emirates, PDE5I naïve, and sexually active. PDE5Is were selected per routine clinical practice. Persistence was defined as use of ≥1 dose during the prior 4 weeks, adherence as compliance with dosing instructions during the most recent dose. Logistic regression models were used to identify factors associated with persistence and adherence.

MAIN OUTCOME MEASURES

Persistence and Adherence Questionnaire; Partner Relationship Questionnaire; Self-Esteem and Relationship Questionnaire; International Index of Erectile Function (IIEF); Erectile Dysfunction Inventory of Treatment Satisfaction.

RESULTS

Patients' (n = 493) mean age was 49.8 years, mean BMI was 29.3, and the majority (n = 354, 71.8%) were from Saudi Arabia. Tadalafil was the most prescribed PDE5I (69.6%), versus sildenafil (15.4%), or vardenafil (15.0%). Patients' mean IIEF-Erectile Function scores improved from moderate to mild and Erection Hardness Scores (SD) improved from 1.8 (1.0) at baseline to 3.5 (0.7) at 6 months. At 6 months, 64.9% of patients were treatment persistent (tadalafil, 68.8%, sildenafil, 65.8%, and vardenafil, 45.9%) and 59.6% were adherent. Factors significantly predictive (p < 0.05) of persistence at 6 months included age, employment status, and ED severity. Factors significantly predictive of adherence were age, employment status, and duration of ED. Interpretation of differences between drugs was limited by substantial differences in prescription rates between countries.

CONCLUSIONS

At 6 months, 64.9% of men were treatment persistent. In this study, age, employment status, ED severity, and duration of ED were associated with persistence and/or adherence.

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.

Androgen receptor expression relationship with semen variables in infertile men with varicocele

PURPOSE

Androgen receptor, a member of the nuclear receptor superfamily, has important roles in male reproductive function. It is required for sexual differentiation, pubertal development, spermatogenesis regulation, meiosis completion and spermatocyte transition to haploid round spermatids. We assessed the association of androgen receptor expression and semen variables in infertile men with varicocele.

MATERIALS AND METHODS

A total of 299 men were grouped into healthy, fertile controls, infertile men without varicocele and men with infertility associated with varicocele. A history was obtained, clinical examination and semen analysis were done and reproductive hormones were estimated. Androgen receptor expression and the acrosome reaction were determined in recovered spermatozoa.

RESULTS

Androgen receptor expression was significantly decreased in infertile men with varicocele more than in infertile men without varicocele compared to fertile controls. Androgen receptor correlated positively with sperm count, motility, normal forms, velocity, linear velocity, acrosome reaction and α-glucosidase. It correlated negatively with serum follicle-stimulating hormone and estradiol. Multiple stepwise regression analysis of androgen receptor expression revealed that the sperm acrosome reaction and linearity index were the most affected independent variables.

CONCLUSIONS

Androgen receptor expression was significantly decreased in infertile men with varicocele more than in infertile men without varicocele compared to fertile men. Androgen receptor expression correlated positively with sperm count, motility, normal forms, velocity, linear velocity and acrosome reaction.

Effect of smoking on sperm vitality, DNA integrity, seminal oxidative stress, zinc in fertile men

OBJECTIVE

To assess the effect of smoking on sperm vitality, sperm DNA integrity, semen reactive oxygen species, and zinc levels in fertile men.

METHODS

One-hundred sixty men were investigated. They were divided into 2 equal groups: healthy fertile nonsmokers and healthy fertile smokers. They were subjected to history taking, clinical examination, and semen analysis. In their semen, sperm hypo-osmotic swelling test, sperm DNA fragmentation test, seminal reactive oxygen species, and zinc were assessed.

RESULTS

Compared with fertile nonsmokers, fertile smokers were significantly associated with lower hypo-osmotic swelling test and seminal zinc levels and significantly associated with higher sperm DNA fragmentation percent and seminal reactive oxygen species levels.

CONCLUSION

Smoking (cigarettes/day and duration) has detrimental effects on sperm motility, viability, DNA fragmentation, seminal zinc levels, and semen reactive oxygen species levels, even in fertile men, and it is directly correlated with cigarette quantity and smoking duration.

Seminal clusterin gene expression associated with seminal variables in fertile and infertile men

PURPOSE

CLU is a disulfide linked, heterodimeric protein associated with the clearance of cellular debris and apoptosis. We assessed the association of seminal CLU gene expression with seminal variables in fertile and infertile men.

MATERIALS AND METHODS

A total of 124 men were divided into healthy, fertile men with normozoospermia, and men with asthenozoospermia, asthenoteratozoospermia and oligoasthenoteratozoospermia. History was obtained, and clinical examination and semen analysis were done. In semen we assessed sperm acrosin activity, sperm DNA fragmentation and seminal CLU gene expression.

RESULTS

CLU RNA and CLU protein gene expression were significantly increased in semen samples of infertile men with oligoasthenoteratozoospermia > asthenoteratozoospermia > asthenozoospermia compared with healthy, fertile controls. CLU gene expression significantly correlated negatively with sperm count, motility, acrosin activity index, linearity index and linear velocity, and significantly correlated positively with the percent of sperm abnormal forms and DNA fragmentation.

CONCLUSION

CLU gene expression was significantly increased in the semen samples of infertile men. It correlated negatively with sperm count, motility, acrosin activity, linearity index and linear velocity, and positively with the percent of sperm abnormal forms and DNA fragmentation.

Ultrastructure of the seminiferous tubules in oligoasthenoteratozoospermic men associated with varicocele

Varicocele is associated with venous reflux that may cause increased heat and interstitial pressure within the testes, with variable pathological effects on spermatogenesis. This study aimed to study the ultrastructural testicular changes in the seminiferous tubules of 20 infertile severe oligoasthenoteratozoospermia (OAT) men associated with varicocele and five patients with obstructive azoospermia without varicocele as controls. They were subjected to testicular biopsy which was evaluated by transmission electron microscopy. Ultrastructurally, the seminiferous epithelium in the testicular biopsies of infertile severe OAT men associated with varicocele was variably affected in the form of thickening of the peritubular connective tissue, vacuolation of Sertoli cell and germ cell cytoplasm, presence of degenerated and apoptotic cells among the germinal epithelium, altered spermatids and abnormal spermatozoa. It is concluded that varicocele in severe OAT men is associated with ultrastructural changes in the seminiferous tubule.

Cavernous antioxidant effect of green tea, epigallocatechin-3-gallate with/without sildenafil citrate intake in aged diabetic rats

This study aimed to assess the cavernous antioxidant effect of green tea (GT), epigallocatechin-3-gallate (EGCG) with/without sildenafil citrate intake in aged diabetic rats. One hundred and four aged male white albino rat were divided into controls that received ordinary chow, streptozotocin (STZ)-induced aged diabetic rats, STZ-induced diabetic rats on infused green tea, induced diabetic rats on epigallocatechin-3-gallate and STZ-induced diabetic rats on sildenafil citrate added to EGCG. After 8 weeks, dissected cavernous tissues were assessed for gene expression of eNOS, cavernous malondialdehyde (MDA), glutathione peroxidase (GPx), cyclic guanosine monophosphate (cGMP), and serum testosterone (T). STZ-induced diabetic rats on GT demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats. Diabetic rats on EGCG demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats or diabetic rats on GT. Diabetic rats on EGCG added to sildenafil showed significant increase in cavernous eNOS, cGMP and significant decrease in cavernous MDA compared with other groups. Serum T demonstrated nonsignificant difference between the investigated groups. It is concluded that GT and EGCG have significant cavernous antioxidant effects that are increased if sildenafil is added.

Effects of a water-soluble curcumin protein conjugate vs. pure curcumin in a diabetic model of erectile dysfunction

INTRODUCTION

Curcumin is involved in erectile signaling via elevation of cyclic guanosine monophosphate (cGMP).

AIM

Assessment of the effects of water-soluble curcumin in erectile dysfunction (ED).

METHODS

One hundred twenty male white albino rats were divided into: 1st and 2nd control groups with or without administration of Zinc protoporphyrin (ZnPP), 3rd and 4th diabetic groups with or without ZnPP, 5th diabetic group on single oral dose of pure curcumin, 6th diabetic group on pure curcumin administered daily for 12 weeks, 7th and 8th diabetic groups on single dose of water-soluble curcumin administered with or without ZnPP, 9th and 10th diabetic groups on water-soluble curcumin administered daily for 12 weeks with or without ZnPP. All curcumin dosage schedules were administered after induction of diabetes.

MAIN OUTCOME MEASURES

Quantitative gene expression of endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), inducible NOS (iNOS), heme oxygenase-1 (HO-1), nuclear transcription factor-erythroid2 (Nrf2), NF-Кβ, and p38. Cavernous tissue levels of HO and NOS enzyme activities, cGMP and intracavernosal pressure (ICP).

RESULTS

Twelve weeks after induction of diabetes, ED was confirmed by the significant decrease in ICP. There was a significant decrease in cGMP, NOS, HO enzymes, a significant decrease in eNOS, nNOS, HO-1 genes and a significant elevation of NF-Кβ, p38, iNOS genes. Administration of pure curcumin or its water-soluble conjugate led to a significant elevation in ICP, cGMP levels, a significant increase in HO-1 and NOS enzymes, a significant increase in eNOS, nNOS, HO-1, and Nrf2 genes, and a significant decrease in NF-Кβ, p38, and iNOS genes. Water-soluble curcumin showed significant superiority and more prolonged duration of action. Repeated doses regimens were superior to single dose regimen. Administration of ZnPP significantly reduced HO enzyme, cGMP, ICP/ mean arterial pressure (MAP), HO-1 genes in diabetic groups.

CONCLUSION

Water-soluble curcumin could enhance erectile function with more effectiveness and with more prolonged duration of action.

Sperm DNA and RNA abnormalities in fertile and oligoasthenoteratozoospermic smokers

This study aimed to assess sperm DNA and RNA abnormalities in fertile and oligoasthenoteratozoospermic (OAT) smokers. In all, 140 subjects were included and classified into fertile nonsmokers, fertile smokers, OAT nonsmokers and OAT smokers. They were subjected to history taking, clinical examination, semen analysis, assessment of sperm DNA and RNA abnormalities. The results showed that an increased percentage of abnormal sperm DNA and RNA was demonstrated in fertile smokers compared with fertile nonsmokers and in OAT smokers compared with OAT nonsmokers. Increased percentage of severe, moderate sperm DNA and RNA damage was demonstrated in fertile heavy smokers compared with fertile light smokers and in OAT heavy smokers compared with OAT light smokers. It is concluded that smoking has a negative impact on sperm DNA and RNA abnormalities that is accentuated in heavy smokers compared with light smokers.

Effect of testosterone and frequent low-dose sildenafil/tadalafil on cavernous tissue oxidative stress of aged diabetic rats

This study aimed to assess the effect of testosterone (T) administration and chronic low-dose sildenafil/tadalafil on cavernous tissue oxidative stress (OS) of aged diabetic rats. In all, 140 Sprague-Dawley aged rats were subdivided into the following: controls; streptozotocin (STZ)-induced diabetic rats; diabetic rats injected with T every 4 weeks; diabetic rats on sildenafil orally daily; diabetic rats on T and daily sildenafil; diabetic rats on tadalafil orally every other day; diabetic rats on T and tadalafil; diabetic rats on alternate sildenafil/tadalafil; and diabetic rats on alternate sildenafil/tadalafil with T. After 12 weeks, the rats were euthanised where in dissected cavernous tissues malondialdehyde (MAD), glutathione peroxidase (GPx) and cGMP (cyclic guanosine monophosphate) were estimated. Compared with controls, aged diabetic rats demonstrated significant increase in cavernous tissue MDA and significant decrease in GPx and cGMP where diabetic rats injected with T had marked improvement of these parameters. Diabetic rats on sildenafil, tadalafil or alternate sildenafil/tadalafil demonstrated significant increased cavernous tissue GPx, cGMP and decreased cavernous MDA that was further improved when supplemented with T. It is concluded that frequent low-dose use of sildenafil and/or tadalafil supplemented with T has a marked impact on ameliorating cavernous OS in aged diabetic rats.

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.

Ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative repair

Varicocele has been identified as an important cause of male infertility where its influence on men's reproductive capacity is due to its markedly diverse effects on the testicles. This study aimed to assess the value of ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative evaluation. Forty-five infertile men associated with varicocele and 15 fertile men were subjected to history taking, genital examination and semen analysis. In addition, inguinal and scrotal ultrasonography was carried out pre-varicocelectomy and 3 months post-varicocelectomy. At both the scrotal or inguinal levels, the mean spermatic vein diameter demonstrated significant post-operative decrease compared with the pre-operative resting condition and on Valsalva' manoeuvre. The mean diameters of the pampiniform plexus of veins also demonstrated significant decreases post-operatively compared with the pre-operative resting condition or on Valsalva' manoeuvre. It is concluded that colour Doppler ultrasound is a reliable and noninvasive method that is useful not only for diagnosis but also for post-varicocele repair follow-up.

Effect of smoking status on seminal parameters and apoptotic markers in infertile men

PURPOSE

We assessed semen parameters, sperm apoptotic markers and seminal plasma cotinine in infertile smokers.

MATERIALS AND METHODS

A total of 160 men were divided into 4 equal groups, including fertile smokers, fertile nonsmokers, infertile smokers and infertile nonsmokers. Smoking was classified as mild--fewer than 10, moderate--10 to 20 or heavy--more than 20 cigarettes daily. All men underwent semen analysis, and assessment of sperm caspase-9, Smac/DIABLO, DNA fragmentation and seminal plasma cotinine.

RESULTS

Infertile men, particularly smokers, have significantly lower semen variables and significantly higher sperm Smac/DIABLO, caspase-9 activity, the percent of DNA fragmentation and seminal plasma cotinine. The mean number of cigarettes smoked daily and smoking duration significantly correlated positively with sperm Smac/DIABLO, caspase-9 activity, the percent of DNA fragmentation and seminal plasma cotinine, and significantly correlated negatively with tested semen variables. Heavy smoking was associated with a significant increase in sperm Smac/DIABLO, caspase-9 activity and seminal plasma cotinine, and with a significant decrease in tested semen variables compared with those in moderate or mild smokers.

CONCLUSIONS

Smoking has a negative impact on semen variables. It is associated with increased sperm caspase-9, Smac/DIABLO and the percent of DNA fragmentation, especially in infertile heavy smokers.

Sperm caspase-9 in oligoasthenoteratozoospermic men with and without varicocele

OBJECTIVE

To assess sperm caspase-9 activity in infertile oligoasthenoteratozoospermic (OAT) men with and without varicocele.

DESIGN

Prospective.

SETTING

Academic setting.

PATIENT(S)

Eighty men: healthy fertile control subjects (n = 20), OAT (n = 25), and OAT associated with left-side varicocele (n = 35).

INTERVENTION(S)

History taking, clinical examination, semen analysis,assessment of seminal caspase-9.

MAIN OUTCOME MEASURE(S)

Semen analysis, sperm caspase-9.

RESULT(S)

Sperm caspase-9 was significantly increased in infertile OAT men associated with varicocele compared with OAT men without varicocele and healthy fertile control subjects. Sperm casapse-9 activity demonstrated significant negative correlation with sperm count, sperm motility, sperm velocity, sperm linear velocity, sperm linearity index, and sperm normal morphology.

CONCLUSION(S)

Sperm caspase-9 is exaggerated in infertile OAT cases with varicocele compared with infertile OAT cases without varicocele or healthy fertile men. Sperm caspase-9 demonstrated significant negative correlation with semen variables.

Seminal fibronectin in fertile and infertile males

This study aimed to assess seminal plasma fibronectin in fertile and infertile males. Ninety infertile males were investigated; asthenozoospermia (n = 27), asthenoteratozoospermia (n = 30), oligoasthenoteratozoospermia (n = 33) compared with 20 healthy fertile controls. They were subjected to semen analysis, seminal plasma fibronectin estimation by radial immune diffusion, serum testosterone (T) and follicle stimulating hormone (FSH) estimation by ELISA. There was significant increase of seminal plasma fibronectin among different infertile groups compared with the controls. Significant negative correlation was elicited between seminal fibronectin and sperm count, sperm motility grades A, B, A + B, sperm velocity, linear velocity, linearity index, sperm normal forms and serum T. Seminal fibronectin showed significant positive correlation with grade D sperm motility and serum FSH. ROC curve analysis discriminating controls and other infertile groups demonstrated criteria value of < 674 mg l(-1) (sensitivity 100% and specificity 96.4%). It is concluded that increased seminal fibronectin is associated with decreased sperm count and sperm motility.

Androgen receptor-CAG repeats in infertile Egyptian men

This study aimed to assess the androgen receptor (AR) codon amino acids glutamine (CAG) repeats in 185 Egyptian men divided into fertile controls (n = 30), oligoasthenoteratozoospermic (OAT) men (n = 35), nonobstructive azoospermic (NOA) men (n = 120; 18 successful testicular sperm extraction (TESE) and 102 unsuccessful TESE cases). They were subjected to history taking, genital examination, semen analysis, testicular biopsies for NOA cases, serum hormones and CAG repeats by PCR. The mean AR-CAG repeats showed significant difference between NOA group compared with fertile controls or OAT groups. Nonsignificant difference was elicited between OAT group and fertile controls. In NOA cases, CAG repeats demonstrated nonsignificant difference between unsuccessful and successful TESE. AR-CAG repeats elicited significant negative correlation with sperm count, significant positive correlation with sperm normal forms percentage and nonsignificant correlations with sperm motility per cent, tested serum hormones or testicular volume. It is concluded that AR-CAG repeats in Egyptian infertile men are in the range of other international or regional studies. AR-CAG repeats have demonstrated nonsignificant difference regarding TESE outcome in NOA cases.

Effect of nicotine on spermatogenesis in adult albino rats

This study aimed to assess the effects of nicotine on spermatogenesis in 140 mature male albino rats divided into group A (controls), group B (sham controls), group C (nicotine treated) and group D (nicotine withdrawal). Group C was subdivided into CI, CII, CIII according to the dose of injected nicotine (0.2, 0.4 and 0.6 mg nicotine per 100 g per day), where each subgroup was further subdivided according to the treatment duration into subgroups a, b and c that received nicotine for 2, 4 and 8 weeks. Group D received nicotine for 8 weeks followed by withdrawal for another 8 weeks to assess testicular recovery. Testicular tissue sections were subjected to haematoxylin and eosin, Masson's trichrome stains and morphometry. The results showed that nicotine caused degenerative changes in the seminiferous tubules, revealed by altered general tubular architecture, decreased thickness of the spermatogenic cell masses, Sertoli cell vacuolation and thickened basal lamina. These changes were proportional to the nicotine dose and duration. Following nicotine withdrawal, regeneration of the damaged seminiferous tubules was observed to be rather complete in CI group. It is concluded that nicotine could adversely affect testicular spermatogenesis in a dose- and time-dependent manner which would be almost reversible after nicotine withdrawal, especially after small doses.

Semen and hormonal parameters in men with chronic hepatitis C infection

Male patients with chronic hepatitis C virus (HCV) infection (n = 57) demonstrated a statistically significant decrease in semen volume, sperm count, and progressive sperm motility and a statistically significant increase in abnormal sperm morphology compared with healthy controls (n = 40). The duration of the HCV infection was negatively correlated with semen volume and sperm motility where the HCV RNA viral load was negatively correlated with sperm count and sperm motility. Chronic HCV patients had statistically significantly lower total serum testosterone and higher serum E(2) and prolactin levels compared with healthy controls.

Seminal plasma reactive oxygen species-antioxidants relationship with varicocele grade

This work aimed to assess seminal plasma reactive oxygen species (ROS)-antioxidants relationship with varicocele grade in infertile men with oligoasthenoteratozoospermia (OAT). The study included 89 infertile OAT men with varicocele divided into grade I (n = 22) and grade II (n = 43), grade III (n = 24) and compared with 20 healthy fertile controls. In their seminal plasma, two ROS parameters (malondialdehyde [MDA], hydrogen peroxide [H(2) O(2) ]) and four antioxidants (superoxide dismutase [SOD], catalase [Cat], glutathione peroxidase [GPx], vit.C) were estimated. There was significant increase in seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C in varicocele-associated OAT cases when compared with the controls. Compared with grade I cases, varicocele cases with grades II, III demonstrated significant increase in estimated seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C. It is concluded that seminal oxidative stress (OS) is related to increased varicocele grade in infertile OAT men associated with varicocele.

Radiologically assessed testicular changes in infertile males with varicocele

The aim of this study was to assess vascular disturbances in the testis of infertile males associated with varicocele. In total, 124 consecutive male subjects were divided into the following groups: healthy fertile controls (n = 10), Gp1 (n = 28); infertile males with subclinical varicocele, Gp2 (n = 26); infertile males with grade I left varicocele, Gp3 (n = 28); infertile males with grade II left varicocele and Gp4 (n = 32); infertile males with grade III left varicocele. They were subjected to colour duplex for pampiniform plexus and scrotal scintigraphy. There was significant decrease in arterial blood velocity, testicular arterial diameters and testicular perfusion especially in high grade varicocele compared with healthy controls. The mean vein diameter demonstrated significant negative correlation with arterial diameter, arterial blood velocity, perfusion index, testicular size and significant positive correlation with perfusion index. The mean testicular size demonstrated significant positive correlation with arterial blood velocity, perfusion index and nonsignificant correlation with arterial diameter. It is concluded that there are significant decreases in testicular volume, testicular perfusion, blood velocity and testicular artery diameter in infertile males with varicocele.

Rehabilitation of the cavernous smooth muscle in patients with organic erectile dysfunction

This study aimed at assessing the effect of regular use of intracorporeal injection (ICI), sildenafil citrate and vacuum constriction device (VCD) on cavernous smooth muscle and erectile activity. One hundred and sixty-five patients with organic erectile dysfunction were investigated for 3 months. The patient and his partner were classified prospectively after proper counselling: group I (n = 56) received ICI twice per week; group II (n = 55) received sildenafil 100 mg twice per week; and group III (n = 54) used VCD twice per week. Duplex ultrasound was carried out before and after treatment, and then, the patients were followed up for a month to assess the resumption of unaided erection. The results showed that there was significant improvement in mean peak systolic velocity (PSV) and mean cavernosal artery diameter (CAD) at the end of the treatment in all groups, being higher in the ICI group than in the other two groups. Also, the percentage of patients who resumed unaided intercourse were higher in the ICI group compared with the other two groups (17.9%, 9.1% and 3.7% respectively). It is concluded that repeated regular use of ICI, sildenafil or VCD by patients with organic erectile dysfunction has a positive impact on their cavernous blood flow and erectile activity.

Testicular schistosomiasis: a case study

OBJECTIVE

To report a case of testicular schistosomiasis.

DESIGN

Case study.

SETTING

University hospital.

PATIENT(S)

A 26-year-old unmarried Egyptian man presented with slowly growing painless swelling at the right hemiscrotum.

INTERVENTIONS

Physical examination, scrotal ultrasonography, magnetic resonance imaging (MRI), computerized tomography, urine and semen Zeihl-Neelsen stain, stool, serum alpha-fetoprotein, FSH, LH, PRL, E2, total testosterone (T), and surgical exploration.

MAIN OUTCOME MEASURE(S)

Clinical, laboratory, radiologic, and histopathologic data.

RESULT(S)

At clinical examination, there was a large painless swelling in the right hemiscrotum with two hard masses felt subcutaneously. The transillumination test was negative with no inguinal lymphadenopathy. The left hemiscrotum revealed normal findings. Serum alpha-fetoprotein, FSH, LH, total T, E2, and PRL were within normal. MRI demonstrated no masses of abnormal signal intensity or enhancement. Scrotal surgical exploration revealed discharge of thick brownish red pus with presence of two hard extratesticular scrotal masses. Histopathology of the right testis biopsy revealed reduced diameter of the seminiferous tubules with marked hypospermatogenesis where the interstitium was filled by multiple Schistosoma mansoni ova associated with granulomatous reaction compressing the tubules.

CONCLUSION(S)

Scrotal involvement in schistosomiasis with its variable presentations should be considered in diagnosing scrotal masses, especially in endemic areas.