Alaa Tealab

Defining a Hba1c Value That Predicts Increased Risk Of Penile Implant Infection

To re‐evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection.

Erect Penile Dimensions in a Cohort of 778 Middle Eastern Men: Establishment of a Nomogram

INTRODUCTION Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size. AIM The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men. METHODS A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronies disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma. MAIN OUTCOME MEASURES Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix. RESULTS Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006). CONCLUSION A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises.

The Role of Urinary Interleukin-8 Level in Diagnosis and Differentiation between Different Types of Urinary Tract Infection in Children

Background: Interleukin (IL)-8 acts as a potent neutrophils chemotactant responsible for the migration of neutrophils into the infected renal tissue to protect against invading pathogens. The aim of our work was to identify the role of urinary IL-8 in the diagnosis and differentiation between different forms of urinary tract infections (UTI) and its role in detection of the effect of treatment. Materials and Methods: Fifty children with different forms of UTI were evaluated and classified into three groups: Group I included 20 children diagnosed as having pyelonephritis (age range 6 months–10 years), Group II included 15 children with acute cystitis (age range 1–12 years) and Group III included 15 children with asymptomatic bacteruria (age range 5 months–10 years) and group III was considered as the control group as bacteriuria was detected during routine urine examination. All groups were urine culture positive. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography and dimercaptosuccinic acid renal scintigraphy (DMSA) were evaluated in these children. The ratios of urinary IL-8 to creatinine (IL-8/Cr) before and after the treatment at 72 hours were compared with each other. Results: The initial urine IL-8 concentrations were significantly higher in group I than in group II and also higher than group III (all p < 0.001). After 72 hours the urinary IL-8 level significantly decreased in all groups studied (all p < 0.001). There were positive correlations between urine IL-8 concentrations and leukocyturia in children with acute pyelonephritis (r = 0.43, p < 0.001). In children with the lower UTI group, no correlations were found between urine IL-8 values and leukocyturia. Renal injury was found in 6 children with pyelonephritis detected by dimercaptosuccinic acid renal scintigraphy scanning and these 6 patients had the highest level of urinary IL-8 among those of the pyelonephritis group after 6 months. Conclusion: From this study it is concluded that the importance of urinary IL-8 as a non-invasive test in diagnosis and differentiation between different forms of UTIs in children (upper UTI from lower UTI and from those with asymptomatic bacteruria) and also its importance in detection of treatment efficacy.

Malleable Penile Implant Is an Effective Therapeutic Option in Men With Peyronie’s Disease and Erectile Dysfunction

Background The inflatable penile prosthesis (IPP) is typically the preferred implant for Peyronie’s disease (PD) and malleable penile prostheses (MPPs) have been discouraged. Aims To evaluate the effectiveness and patient satisfaction of the MPP vs IPP in patients with PD. Methods Men with PD and erectile dysfunction who elected for penile implant surgery constituted the study population. Preoperatively, demographic and comorbidity parameters were recorded. Curvature was measured with a goniometer at maximum rigidity after intracavernosal injection of a vasoactive agent. Postoperatively, overall satisfaction was measured at 3, 6, 12, and 24 months on 5-point Likert scale from 1 (dissatisfied) to 5 (very satisfied). Results 166 men with a mean age of 59 ± 10 years were analyzed. The mean preoperative curvature in the entire cohort was 65° (range = 30–130°). 94% of patients with MPP had total resolution of their curvature at the end of the operation, whereas 8 patients (6%) had residual curvature (25–40°). In the IPP group 25 of 30 (83.3%) had a straight penis at the end of surgery, whereas 5 of 30 (16.7%) had residual curvature, with the mean magnitude being 33° in the MPP group and 30° in the IPP group. 86% of all patients had diabetes. There were no differences between the 2 implant groups in age, hemoglobin A1c, body mass index, or smoking status. The mean patient satisfaction was 4.42 ± 0.70 (range = 2–5) and there was no difference between the 2 groups. The mean follow-up period was 23.4 months (range = 6–29 months). Conclusion We found that the MPP is as effective as the IPP in curvature correction in patients with PD, with similar patient satisfaction for the 2 groups. Habous M, Farag M, Tealab A, et al. Malleable Penile Implant Is an Effective Therapeutic Option in Men With Peyronie’s Disease and Erectile Dysfunction. Sex Med 2018;6:24–29.

Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short-course randomized study

To compare serum testosterone response and symptom improvement in men with hypogonadism in response to treatment with clomiphene citrate (CC), human chorionic gonadotropin (hCG), or a combination of both therapies.

PD22-11 A CUT-OFF HBA1C VALUE OF 8.5% PREDICTS INCREASED RISK OF PENILE IMPLANT INFECTION

more common in patients with versus without transplant (26.9% v 3.9%, p 0.021), as was stroke (19.2% v 0.0%, p 0.05) and diabetes (84.6% v 53.6%, p 0.016). No significant differences in reoperation rates existed between patients with versus without transplant (7.7% v 11.5%, p 1.00), nor between the type of organ transplanted (p 1.00). No differences in reoperation rate by implant model (2-piece versus 3-piece) were noted (p 0.47). CONCLUSIONS: This study shows that outcomes of penile prosthesis placement in solid organ transplantation patients do not differ from those in non-transplant patients. Additionally both 2-piece and 3-piece implants had similar outcomes. Penile prostheses appear to be a safe option for treating erectile dysfunction in solid organ transplant recipients.

The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia

Abstract Objectives: To assess the use of an acellular collagen matrix (Pelvicol, Bard Medical, Covington, GA, USA), a successful agent for reconstructive surgery, for enhancing penile girth. Patients and methods: Between June and December 2011, 18 patients (mean age 24 years, range 19–38) had their penis augmented with Pelvicol; the mean (range) penile circumference was 9.2 (7–13) cm before treatment. They were divided into two groups; the first (10 patients) had a Pelvicol sheet of 8 × 12 cm inserted through a V–Y suprapubic incision and wrapped around the shaft in a bilayer under the dartos fascia, but not covering the urethra, with division of the suspensory ligament. The second group of eight patients had the Pelvicol inserted through a subcoronal degloving incision and placed in one layer. The penile circumference was measured at 6 and 12 months after surgery. Patient satisfaction at 1 year after surgery was assessed as ‘poor’, ‘unsatisfied’, ‘moderately satisfied’, ‘highly satisfied’, or ‘excellent’. Results: The mean (range) increase in girth (circumference) was 2.8 (2–3.2) cm in group 1 and 1.7 (1.2–2) cm in group 2. In group 1, two patients were highly satisfied, four moderately satisfied and four unsatisfied; in group 2, three were moderately satisfied and five unsatisfied. Complications were common in both groups, with five patients in group 1 and three in group 2 developing severe penile oedema and ischaemic shaft ulcers. Removal of the graft was required in two patients in each group. Conclusion: This pilot study shows that Pelvicol is not an ideal option for enhancing penile girth, and the method of placement did not apparently influence the result.