Mohamed Farid Roaiah

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.

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.

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.

Study of the prevalence of 5 HT-2C receptor gene polymorphisms in Egyptian patients with lifelong premature ejaculation

We investigated the prevalence of 5HT2C receptor gene polymorphisms in Egyptian patients with lifelong premature ejaculation. A total of 350 participants were enrolled in a prospective study. Two hundred and forty‐five cases with lifelong premature ejaculation joined this study, in addition to 105 controls. We instructed the partners of the cases to measure the IELT of the first intercourse only using a stopwatch for 1 month. Genotyping was carried out at the end of the study. The results showed that the majority of the patients and controls were Cys/Cys. A highly significant statistical association was found between the studied gene polymorphisms and IELT among cases (p‐values = .009). The study emphasised the potential role of 5HT2C 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

ABSTRACT 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.

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 0–2), the medium-risk group (EuroSCORE 3–5), 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.

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 of the Surgical Outcomes after Semirigid Penile Implant and their Impact on the Patients’ and their Partners’ Satisfaction Rate Human Andrology

Purpose: The current study assessed the surgical outcomes of the semirigid implant and their impact on the patient’s and the partner’s satisfaction. To the best of our knowledge, this is the first study to highlight the essential role of both radial and axial rigidities in patients’ and partners’ satisfaction. Patients and methods: The study included 32 patients and their partners. Their penile duplexes and Rigiscan proved the diagnosis. Subcoronal approach was adopted to insert the implant. Structured interview was carried out to evaluate the surgical outcomes using a 10-question questionnaire to evaluate the patients’ and their partners’ satisfaction rate prospectively, at 1, 3, and 6 months, respectively. Spearman’s rank correlation coefficient or Spearman’s ρ was used. Results: In our patients, we found moderate satisfaction rates for the majority of both patients and their partners. The current study revealed that the majority of the study patients were complaining of poor radial rigidity and dropped penis, which had an adverse impact on the overall satisfaction of the patient. A significant relationship was revealed between reimplantation and poor radial rigidity. Age demonstrated a significant correlation with poor circumferential rigidity and dropped penis. As regards the female partners, they showed a significant positive correlation between their negative responses and poor radial rigidity. Conclusion: This study highlighted the adverse impact of poor radial rigidity on patient satisfaction rate, which can be avoided with proper surgical technique. In addition, proper counseling is essential, especially for older patients, about the possibility of poor radial rigidity and dropped penis as they may push them to remove the implant.