Rany Shamloul

Sustained Normalization of High Blood Pressure in Spontaneously Hypertensive Rats by Implanted Hemin Pump

Treatment of established hypertension, especially for prolonged control of this pathogenic process, represents a great challenge. To upregulate the expression of heme oxygenase (HO) to lower blood pressure (BP) of spontaneously hypertensive rats (SHRs), we administered hemin to 12-week-old adult SHRs through subcutaneously implanted osmotic minipumps for 3 consecutive weeks (the hemin protocol). Systolic BP of SHRs was normalized 123±2 mm Hg (n=20; P<0.001) and this normalization maintained for 9 months after the removal of hemin pumps. At the end of the hemin protocol, HO-1 expression, HO activity, soluble guanylyl cyclase expression, and cGMP content were all increased, but phosphodiesterase-5 expression was downregulated in the mesenteric arteries. The hemin protocol also reversed SHR-featured arterial eutrophic inward remodeling and decreased expression levels of vascular endothelial growth factor. These changes lasted 9 months after the hemin protocol. Our study, thus, formulates a novel hemin protocol that will not only normalize BP in SHRs with established hypertension but, more importantly, will also provide long-lasting antihypertension protection. Sustained upregulation of HO-1–linked signaling pathways and reversal of vascular remodeling in peripheral blood vessels mediate likely the antihypertensive effect of the hemin protocol.

Increased Intracavernosal Pressure Response in Hypertensive Rats After Chronic Hemin Treatment

INTRODUCTION Erectile dysfunction (ED) is increased in prevalence in patients with arterial hypertension. Whether upregulation of heme oxygenase (HO) expression could improve penile erection has been unknown. AIMS To correlate altered expression profiles of HO-1 and soluble guanylyl cyclase (sGC) in penile tissues with low intracavernosal pressure (ICP) in adult spontaneously hypertensive rats (SHR); and to investigate therapeutic effect of hemin-induced upregulation of HO-1 in penile tissues on ED developed in adult SHR. METHODS AND MAIN OUTCOME MEASURES Intracavernosal pressure changes after electrical stimulation were monitored in adult SHR and age-matched normotensive Sprague-Dawley (SD) rats after chronic administration of either hemin or hydralazine. Expression levels of HO-1, HO-2, sGC, and phosphodiesterase type 5 (PDE5) were examined with Western blot. RESULTS Frequency-dependent ICP changes were reduced in adult SHR. Three weeks after hemin treatment, high blood pressure of SHR was normalized and ICP responses to electrical stimulations in SHR were significantly increased to the level of normotensive rats. Hydralazine-treated SHR had normalized blood pressure but unaltered low ICP response. Expression of HO-1 and sGC was upregulated and that of PDE5 downregulated in hemin-treated, but not hydralazine-treated, SHR. CONCLUSIONS Decreased erectile responses in adult SHR can be improved through chronic hemin treatment. Prolonged upregulation of HO-1 and sGC as well as lowered expression of PDE5 may at least partially explain the effect of hemin treatment on ICP. Upregulation of HO-1 may represent a novel therapeutic approach to treat ED.

Experience with Tube® (Promedon) Malleable Penile Implant

Introduction: The main advantages of semirigid penile prosthesis are simple implantation, ease of use, very low risk of mechanical failure and more financial suitability for patients in developing countries. Aim: To evaluate reliability and safety of Tube® (Promedon, Cordoba, Argentina) penile prosthesis in the surgical treatment of erectile dysfunction. Patients and Methods: This retrospective case series was conducted on 83 patients who underwent Tube penile implant surgeries between 2001 and 2006. The choice of Promedon penile implant was determined by the patient himself. Strict infection control measures were applied. Patients were followed up for stability of vital signs and discharged within 72 h. Results: Successful sexual intercourse was possible for 75 (90.4%) of cases. Common postoperative complaintswere: prosthesis too short in 27 cases (32.5%), not happy with the appearance of the penis in 8 cases (9.6%), non-specific pain which subsided spontaneously in 20 cases (24%), in which no further intervention was done apart from reassurance. 79 (95.2%) patients were on regular follow-up for the first year and the rest dropped out. None of the patients experienced prosthetic infection postoperatively. Crural cross-perforation (4%) was managed intraoperatively. Hematomas (1.6%) were managed conservatively. Retarded ejaculation (10%) and penile hypothesia (0.8%) resolved spontaneously within 6 months in all cases. Conclusion: The Promedon malleable penile prosthesis is reliable and safe in the surgical treatment of erectile dysfunction.

Psychotropics and sexual dysfunction

Introduction Sexual dysfunction (SD) is common in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect compromising treatment compliance. Mechanisms involved in psychotropics–induced SD are either largely unknown or poorly understood. The aim of this review is to present an updated analysis of SD associated with the use of psychotropic drugs in psychiatric patients. Results Contemporary evidence from available studies demonstrates that SD rates are drug–related rather than drug–class specific, and that these rates vary widely. Mechanisms involved in psychotropics–induced SD are either largely unknown or poorly understood. Our understanding of psychotropics–induced SD is limited by the inability to differentiate whether these effects are really drug–induced or due to different inclusion criteria. Conclusions Rigorous research, basic and clinical, is needed to understand the exact incidence, severity and mechanisms involved in the development of SD induced by various psychotropic treatment regimens.

Evaluation of surgical outcome of penile augmentation and lengthening procedures.

Our study included 280 patients complaining of small-sized penis. They were seen in the outpatient clinic of the Andrology Department, Kasr El Aini, Cairo University. Patients were collected from 2002 till 2008 and classified into 4 categories from an etiological point of view. Eleven patients (3.9%) were operated upon according to fine selection criteria; six patients were selected for lengthening procedures, while two patients were selected for increasing girth procedures and three patients for combined operation of lengthening and increasing girth techniques. Seven patients showed subjective satisfaction after lengthening procedures and four patients showed subjective satisfaction after increasing girth techniques. In conclusion, detailed analysis of short penis complaint with a proper diagnosis and patient education are required for accurate management of patients complaining of a short penis.

Functional Anatomy of the Male Sex Organs

The male genital system consists of both external and internal sexual and reproductive organs, including the penis as well as the testis, epididymis, vas deferens, seminal vesicle and the prostate. In this chapter, an overview of the gross and microscopic anatomy of the male genitalia is provided.

JSM HIGHLIGHTSTelemetric Intracavernosal and Intraspongiosal Pressure Monitoring

INTRODUCTION Despite the major breakthroughs basic research in erectile physiology experienced in the last, most of the methods used for quantitative assessment of erectile function in longitudinal studies suffer many drawbacks. OBJECTIVE This review will focus on radiotelemetric assessment of intracavernosal (ICP) and intraspongiosal (ISP) regarding the technique, data collection, interpretation, and overall benefits. RESULTS Telemetric recording of ICP and ISP allows for qualitative and quantitative assessment of erectile responses in experimental animals, a characteristic that is not possible using other techniques. This technique has many advantages that can collectively lead to production of high quality data regarding erection. The system suffers two drawbacks, its high cost and the need for surgical implantation of the transmitter. CONCLUSION The use of telemetric monitoring of ICP and ISP carries many advantages that will, hopefully, establish this technique as the gold standard method for assessment of erectile responses in the near future.