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This study aimed to assess the effect of varicocelectomy and/or mast cells (MCs) stabilizer on sperm DNA fragmentation in infertile men with varicocele (Vx). Overall, 120 infertile patients were randomized to three equal treatment arms; patients that underwent varicocelectomy, patients on 1 mg ketotifen twice daily for three months, and patients that underwent varicocelectomy followed with 1 mg ketotifen twice daily for three months. These patients were subjected to history taking, clinical examination, semen analysis, and estimation of sperm DNA fragmentation index (DFI). After 3 months, all investigated groups showed significant improvement regarding the mean total sperm count, sperm concentration, total sperm motility, and sperm normal forms percentage compared with the pre-treatment data. As well, the mean sperm DFI was significantly improved compared with the pre-treatment data; in men that underwent varicocelectomy (34.6% vs. 28.3%), in men on MC stabilizer only (33.4% vs. 27.8%), and in men that underwent varicocelectomy followed by MC stabilizer (34.3% vs. 25.1%). Sperm DFI improvement percentages showed the highest improvement in men that underwent varicocelectomy followed with MC stabilizer compared with the other two groups (26.8% vs. 18.2%, 16.8%). Sperm DFI improvement percentages showed significant increases in the infertile patients with Vx grade III compared to Vx grade II in all investigated groups. It is concluded that in infertile men associated with Vx and high sperm DFI, surgical repair followed with MCs stabilizer significantly improve sperm DFI compared with either surgical repair or MCs stabilizer alone.

The aim of this study is to evaluate the effectiveness of short-term sildenafil use in the management of unconsummated marriages diagnosed to be mainly psychogenic in origin. This retrospective study included 35 patients evaluated within an Andrology clinic. Patients underwent a complete medical and sexual history as well as a focused physical examination. Investigations were ordered as necessary following a goal-directed approach. Education about the male and female genital anatomy and the sexual response cycle was carried out, as well as a detailed explanation about the concepts of performance anxiety, vaginismus and the mode of action of sildenafil. Sildenafil on demand therapy was initiated for 1 month and the duration extended as needed. Of 35 patients included in our study, 32 (91%) were able to achieve vaginal intromission and perform sexually. In all, 23 patients needed the sildenafil (66%) for less than 1 month, five (14%) for up to 3 months and four (11%) for more than 3 months. Three patients (9%) were unsuccessful. Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause. We conclude sildenafil use is effective as a short-term treatment option in the management of unconsummated marriages.

Introduction Spontaneous penile tumescence after penile prosthesis implantation has been sporadically reported in the literature. Aim To preserve residual erectile function of patients’ spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile prosthesis implantation. Methods Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile prosthesis implantation, and patients undergoing the cavernous tissue–sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. Main Outcome Measures Postoperative changes were compared with the preoperative ones. Results The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue–sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P < .01). In the cavernous tissue–sparing group, 41 of 46 patients (89.13%) reported having a significantly higher incidence of residual penile tumescence vs 7 of 46 patients (15.2%) in the conventional surgery group (P < .001). The postoperative penile girth was significantly higher in the cavernous tissue–sparing group than in the conventional surgery group (11.16 ± 1.1 cm vs 10.11 ± 1.15 cm, P < .001). Clinical Implications This study provides a step-by-step approach to maintaining post-implantation penile tumescence and preserving penile girth in a reproducible manner. Strengths & Limitations This is the first study to demonstrate the benefits of implanting a penile prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. Conclusion It could be concluded that the cavernous tissue–sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative penile tumescence and preserved penile girth.

IntroductionPenile curvature (PC) can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction.ObjectiveTo avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI).Materials and MethodsTwo groups (1&2) were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot technique. In each group of 4 dots the superficial layer of tunica albuginea was transversely incised (3-6mm) at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot.ResultsTwelve (57.1 %) participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005). Postoperative shortening (5mm) of erect penis, encountered in 9 participants, was doubled in group 2 but with insignificant difference (P>0.05). Post-operative recurrence of PC, was encountered in only 1 (4.8%) participant in group 2, compared to none in group 1, with insignificant difference (P>0.05). Post-operative erectile rigidity was normally maintained in all participants.ConclusionThe new technique was superior to the 16-dot technique for correction of PC.