|Year : 2020 | Volume
| Issue : 5 | Page : 1-7
Abstract - SUA202 (Andrology)
|Date of Web Publication||9-Jun-2020|
|How to cite this article:|
. Abstract - SUA202 (Andrology). Urol Ann 2020;12, Suppl S1:1-7
| Empirical therapy for male factor infertility: Survey of the current practice|| |
Abdullah M Al Khayal1,2,3, Faisal K Balaraj1,2,3, Turki A Alferayan4, Mutaz A Al Sait1,2,3, Khalid A Alrabeeah1,2,3, Saad M Abumelha1,2,3
1King Abdullah International Medical Research Center,2King Saud Bin Abdulaziz University for Health Sciences,3Ministry of the National Guard- Health Affairs,4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
E-mail: [email protected], [email protected]
Background: Empirical therapy is usually prescribed by urologist to improve the outcomes of infertility patients. However, there is paucity of data in the literature for infertility. The aim of this study is to assess the clinical practice of urologists regarding the use of empirical therapy in Saudi Arabia.
Methods: An online survey using Google Forms was sent to the participants. The data was collected during Saudi Urological Association Annual Meeting February 2019. Additional data where gathered two months later. The study was closed in May 2019. No incentives were provided to participants.
Results: A total of 96 (80%) urologists participated in the survey, of whom 69.8% were consultants, the percentage of andrology trained urologists was 20.8%. Empirical therapy is used for patients with idiopathic Oligoasthenoteratozoospermia (iOAT) by 86.5% of urologists. Zinc, L-canitine, clomiphene citrate, and L-Arginine were the most prescribed empirical therapies. Hormonal manipulation are mostly used by andrologists. The most significant factors that influence the selection of empirical therapy were: FSH, total Testosterone, and LH levels.
Conclusion: Empirical therapy is used by more than three quarters of the participants for idiopathic male infertility. There are no clear guidelines for the ideal patient and therapy to be considered. Urologists use a wide variety of medications without significant data to support this practice. Development of a well controlled randomized control trials to assess the efficacy of different forms of empirical therapy in male factor infertility is needed.
| Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction|| |
Mohamad Habous, Saleh Binsaleh, Osama Abdelwahab, David Ralph
Jedda, Saudi Arabia,1London, United Kingdom
E-mail: [email protected]
Introduction and Objective: Penile arterial insufficiency (PAI) is a known cause of erectile dysfunction(ED).It was reported that a more generalized perip
heral atherosclerotic process is associated with a severer PAI, and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries. We investigated the risk factors for PAI.
Methods: Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index(BMI) , Peyroni disease(PD)and penile size measurements (length and girth)were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated hemoglobin(HA1c) .Penile duplex ultrasound study(PDU) was done for all patients after intracavernosal injection(ICI) with Alprostadil. peak systolic velocity (PSV)and end diastolic velocity(EDV) were measured after 15 minutes. Statistical analysis was done using SPSS.
Results: A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81),and the mean BMI was 30(18-51). Older patients had lower PSV (r=-0.361, P=0.000)and higher EDV(r=0.174, P=0.001)and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV(r=0.139, P=0.008) which were also highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001)which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV(r=-0.119, P=0.024)which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.
Conclusions: Aging, tobacco consumption, DM and hypertension seem to have a negative impact on penile hemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile hemodynamics in patients with increased BMI, low testosterone, PD or according to the size of the penis.
| Penile intracorporeal injection of autologous mesenchymal stem cells therapy for treatment of erectile dysfunction in diabetic patients; a prospective clinical study|| |
Mohamad Habous, Alaa Refaat1, Hazem Daaf1, Mohammed Farag1, Emadeldine Salah1, Ahmad Wahash1, Sayed Bakray1
Jedda, Saudi Arabia,1Assiut, Egypt
E-mail: [email protected]
Introduction and Objective: To evaluate the efficacy and safety of autologous mesenchymal bone marrow stem cell (MSCs) intracavernosal injection in treatment of diabetic men with erectile dysfunction(ED).
Methods: diabetic men with ED who did not respond to maximum dose of oral PDE5I within last 8 weeks and who agree to participate in the study were included. Exclusion criteria included patients with bone marrow disorders,patients with active malignancy in the last 5 years,patients with cardiovascular disease and glycated hemoglobin >10 .ED was assessed pre injection by International Index of Erectile Function (IIEF) and penile doppler ultrasound study (PDUS).MSCs were harvested and injected after preparation in corpora cavernosa. Patients were closely followed up immediately after therapy and for 6 months for possible side effects,then re-evaluated using IIEF and PDUS.Statistical analysis was done using spss,version 23 for windows.Data are presented as the Mean± standard deviation (SD),frequency, and percentage.Continuous variables were compared by the Student t test (two -tailed).
Results: 25 patients were included in the study but only 10 had complete data and were assessed in this study. Mean age was 52.No side effects or complications related to MSCs therapy recorded in all the 10 patients during the 6 months follow up period . The average IIEF-6 was 12.7 before therapy which significantly improved to be 19.2 after therapy (p=0.026).4 patients out of 10 achieved hard erection adequate for satisfactory coitus, and 2 patients could have satisfactory penetration during sexual intercourse with assistance of sildenafil 100mg.Average peak systolic velocity(PSV) was improved from 25 cm/s to 40 cm/s ,this improvement was statistically significant(P=0.016).Also a statistically significant improvement was noted in end diastolic velocity (EDV) from 3.9cm/s before therapy to 0.9cm/s after therapy(P=0.026).
Conclusions: MSCs therapy seems to be safe and effective in treatment of ED in diabetic patients in short run. Further clinical studies warranted.
| Synergetic effect of hookah smoking on varicocele associated male reproductive impairment in the Saudi community in Al Jouf Region, Saudi Arabia|| |
E-mail: [email protected]
Rationale: As concern to various smoking practices, hookah smoking gains the attention globally as a major public health problem among young adults.
Aim: This study aimed to explore the clinical relationship between the varicocele-associated male infertility with hookah smoking practice in the Saudi community in Al Jouf region.
Methodology: A total number of 192 patients categorized into two groups as varicocele with (HV, n=100) and without hookah smoking (NHV, n=92). Laboratory investigations including hormonal assays such as total testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), and semen analysis (sperm count, sperm motility and sperm morphology) were performed. Ultrasonography based varicocele screening was performed. Varicocele grading was done as per standard criteria.
Results: The prevalence of varicocele Grade 2 and Grade 3 was high in HV groups, 57% and 52.5% respectively. In contrast, Grade 1 was increased in NHV group (55.6%). Regarding seminal analysis, sperm count, sperm motility and sperm morphology were significantly low in the HV group as compared to NHV group. HV groups patients showed the increased diameter of the testicular vein (3.52±0.71) as compared to NHV group (3.42±0.72). Chronic hookah smoking had a statistically significant effect on testosterone (p=0.015) and LH levels (p<0.041) in the HV group.
A significant correlation was observed in sperm count (r= 0.24, p<0.016) and motility (r=0.25, p=0.010) in HV group patients.
Conclusion: Our study concluded that chronic hookah smoking significantly affects the reproductive hormonal and semen parameters in varicocele patients as compared to people with varicocele without hookah smoking. This implies that chronic hookah smoking has an adverse effect on a male reproductive impairment that may play a potential role in the development of further male infertility.
| Which semen parameter is predictive of live birth rate after intracytoplasmic sperm injection cycle in 35 years females or younger – Single center experience|| |
Ali Al-Gonaim, Hossam S. El-Tholoth, Hisham Ayoup, AlShamri Nashmiah, AlKhudar Noor, AlDwsari Atheer, Mussa AlNumi
Email: [email protected]
Introduction and Propose: The introduction of intracytoplasmic sperm injection (ICSI) has revolutionized the infertility treatment. Semen quality plays a major role in the prediction the ICSI outcomes from fertilization, embryo development to live birth. We conduct this study to investigate the probable association of sperm parameters and ICSI outcomes.
Methods: A total of 151 ICSI cycles were reviewed from January 2017 to August 2019 at Prince Sultan Military Medical City IVF Center. Semen analysis performed according to WHO criteria. Patients assigned into two groups, the successful ICSI group (live birth) and the failed one. Sperm parameters were compared between the two groups.
Results: During the study period 150 cycles were done. Take home baby was in 78 cases (52%) and failed group was 72 case (48%). The mean age of the female was 29.7 and 29.5 years old, Female FSH levels were 6.36 and 6.44 IU/L in the two groups, this level was not statistically significant between two groups as well as the female age, number of retrieved oocytes and the mature oocytes and the number of embryo transferred. Regarding the semen parameters sperms count was 17.4 million in the successful group and 20.14 million in the failed group. The mean of normal morphology was 3.01% and 2.96 % in the two groups respectively. The sperm motility was 50.8% in the successful group and 18.6% in the failed group which was statistically significant (P=0.02).
Conclusion: Peri cytoplasmic Sperm Injection semen analysis results showed that the sperm motility has a significant effect on the outcomes.
| A prospective study of the impact of liver transplantation on sexual function in adult males|| |
Noor Nabi Junejo, Raouf Seyam, Dieter Broering1, Said Kattan, Mohamed Kattan, Waleed Altaweel
Departments of1Urology and1Organ Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
E-mail: [email protected]
Objectives: Several patients who present for liver transplantation complain of sexual dysfunction. Liver disease, metabolic or hormonal factors may contribute to the problem. It is not known whether successful liver transplantation will improve sexual function.
Methods: This is a prospective study involving adult married male patients with liver disease presenting for liver transplantation. Patients with severe liver dysfunction requiring hospitalization or causing delirium were excluded. The patients were evaluated before and at least three months post-liver transplantation. This included morning hormonal essays and blood chemistry, an interview using the International Index of Erectile function-15 (IIEF-15), and Chronic Liver Disease Questionnaire (CLDQ-29). Paired T-test was used to compare data before and after transplantation with each patient his own control.
Results: A total of 17 patients were recruited and completed the study. Before transplantation, the mean age was 60.1 SD 8.3 years; weight was 76.5 SD 10.6 kg and height was 168.6 SD 6.1 cm. All domains of the CLDQ-29 significantly improved after transplantation (Abdominal symptoms, Fatigue, Systemic symptoms, Activity, Emotional function and Worry). IIEF-Erectile Function domain improved from 18.1 SD 2.9 to 22.1 SD 3.3 (p = 0.006). All other IIEF-15 domains (Orgasmic function, Sexual Desire, Intercourse Satisfaction, Overall Satisfaction) improved significantly after transplantation. There was no significant change in testosterone level before and after transplantation (10.9 SD 6 and 10.4 SD 5.2 nmol/L respectively, p=0.833). The only two hormones that significantly decreased after liver transplantation were estradiol (271.1 SD 315 and 94.2 SD 49.2 pmol/L respectively, p=0.04) and prolactin (23.1 SD 8.4 and 16 SD 7.1 ug/L respectively, p=0.004).
Conclusions: All domains of sexual function significantly improved after liver transplantation. The recovery was probably attributed to the improvement of liver disease-related quality of life and decrease in prolactin and estradiol levels but not related to an increase in testosterone level.
| Priapism after monoclonal antibody repatha (evolocumab) injection use: Case report|| |
Ahmed A. Alharbi, Ehab Alsayyed, Taha A. Hamoda, Ahmed Abdelsalam, Zuhier Awan1
Departments of Urology and1Clinical Biochemistry, King Abdul-Aziz University, Jeddah, Saudi Arabia
E-mail: [email protected]
Priapism is prolonged and persistent penile erection that is unrelated to sexual interest or stimulation and lasts longer than 4 hours. Three main types of priapism: ischemic, non-ischemic, and stuttering.(1) We report a possible association between Repatha (evolocumab ) injection and priapism in a patient who diagnosed with familial hyperlipidemia that has been defined as a genetic inheritance disease commonly associated with high low-density lipoprotein cholesterol levels , One of the treatment is Repatha (evolocumab ) injection which is a human immunoglobulin G (IgG) subclass 2 monoclonal antibody directed against PCSK9 to block it's binding to LDL receptors . He is 24 years old was diagnosed with familial hyperlipidemia, no allergy from any drugs or substances. He started on Repatha 140 mg. First dose was taken, while prolonged erection started on the next day morning less than 12hr apart from the first injection. it was not painful. Then, it has resolved spontaneously at home with no interventions. Next day he has experienced the same episode, but it was painful and he went to emergency department, the first impression was urinary tract infection and start him on intravenous fluid bolus, paracetamol with ceftriaxone. Pain was controlled, while erection was semi-rigid which was persistent for 9 hours and then resolved spontaneously. With erectile dysfunction and failure to initiate erection with sexual stimulation. These episodes of priapism have been recurred 8 times within 2 weeks and no any intervention was needed. One of the theory that evolocumab cause vascular reactivity ether by excess local nitric oxide production or by increasing blood flow by open blockage of lipid in small vessels in the penial area, still this association unclear and potential role of evolocumab in ED and risk for priapism is an important area for future study.
| Reference|| |
- Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. American Urological Association guideline on the management of priapism. J Urol 2003;170:1318-24.
| Varicocelectomy for scrotal pain: Is it effective?|| |
Abdullah Alkhayal, Sahar Mohammed Aljumaiah, Abdullah Saad Alhaqbani1, Muhannad Abdulaziz Alnahdi1
Urology Department, King Abdulaziz Medical City National Guard Hospital,1College of Medicine, King Saudi bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia
E-mail: [email protected]
Introduction: Varicocele-related pain accounts for 2-10% of all varicocele cases. Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature in this matter is controversial. Data showed the pain may persist after the surgery even if the varicocele is no detected any more postoperatively.
Objectives: To identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and post-operative pain and to identify the need for secondary procedure after varicocelectomy to control the pain.
Methods: Retrospective cohort study conducted with total sample of 47 who underwent varicocelectomy secondary to pain performed between March 2016 and December 2018 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Study included all patients who underwent varicocelectomy due to pain at the mentioned period with no exclusion criteria.
Results: Postoperatively, pain totally resolved after the surgery in 64.3% of patients came with pain and improved in 21.4%, pain hasn't changed in 11.9% of them and pain got worse in 2.4%. Relation of success rate with the grade varies in the literature. Our study showed 100% complete resolution with grade I,85.7% complete resolution and 14.3% improvement in grade II, and 81.3% complete resolution and 18.8% improvement with grade III. We investigate for any additional intervention for pain. Patients who included in our study only 6 patients had done additional intervention post operatively to control their pain, three of them underwent embolization, two had cord block and one sent for pain clinic service for further management.
Conclusion: Great impact of pain resolution presented as 64.3% complete resolution of pain and 21.4% improvement. However, Additional prospective and randomized control trials warranted to guide us for the better surgical decision with high quality evidence of clear benefits.
| Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones?|| |
Adel Elatreisy1,2, Ahmed Ibrahim3, Ahmed Alhadi2, Arvind Ganpule4, Abdulsalam Ahmadi4, Mahmoud Faisal1, Shashikant Mishra4, Ravindra Sabnis4, Melanie Aube2, Serge Carrier2, Mahesh Desai4
1Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia,3Department of Surgery, Division of Urology, McGill University Health Center, Montreal, QC, Canada,4Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
E-mail: [email protected]
Objective: To quantify the predictors for the ancillary treatments after (SWL) for renal and upper ureteral stones.
Methods: From January 2014 to January 2019, patients undergoing SWL using electromagnetic lithotripter machine for renal and upper ureteral stones ≤ 20 mm were retrospectively reviewed. The cohort was subdivided into three groups according to stone attenuation values (HU). Group I; HU <500 (n=42), group II; HU between 500-1000 (n=69) and group III; HU ≥ 1000 (n=196). Univariate and multivariate analysis were performed for prediction of ancillary treatments.
Results: A total of 307 patients were included in the study. The overall SWL success rate was 91.2%. On subgroup analysis, group III required URS and ureteral stenting in 50% of cases, and hospital readmission for persistent renal colic in 20% whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the treatments after SWL (p values <0.05).
Conclusions: Patients with stone attenuation value (HU) >1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones.
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