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Introduction The clinical identification of metabolic syndrome is based on measures of abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and glucose intolerance. However, the impact of hypogonadism associated with obesity on penile hemodynamics is not well investigated. Aim In this retrospective study, we sought to evaluate the effect of obesity on serum total testosterone (TT) level and penile duplex parameters in men with erectile dysfunction (ED). Methods Our participants (N=158) were evaluated for erectile function using an abridged, five-item version of the International Index of Erectile Function-5. Determination of body mass index (BMI) was performed. Measurements of TT, fasting lipid profile, and blood sugar were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Main Outcome Measures Bivariate associations among BMI and serum testosterone, blood pressure, and lipid profile, as well as penile duplex parameters. We compared all clinical, laboratory, and penile duplex parameters between lean men (BMI<25) and overweight and obese men (BMI ≥ 25). Results The participants' age ranged between 20 and 56 years. A significant negative correlation between BMI and TT was detected (r =−0.431, P =0.0001). Hypogonadism was identified in 54/158 (34.2%) of men with ED. The incidence of hypogonadism varied from as low as 1/18 (5.6%) in lean men to as high as 18/36 (50%) to 21/35 (60%) in morbid and severe obesity, respectively. Vasculogenic ED was detected in 32/54 (59.3%) men with BMI ≥ 25, compared with 5/18 (27.8%) in lean men (P =0.029). In order to study the effect of obesity on erectile function, cases with other risk factors were excluded. Of 67 men suffering from ED with no other risk factor(s) apart from obesity, vasculogenic ED was detected in 32/54 (59.3%) men with BMI ≥ 25, compared with 3/13 (23.1%) in lean men (P =0.029). Conclusion Obesity is associated with lower TT and disturbances of penile hemodynamics. It is an independent clinical factor for vasculogenic ED.

Background: Chronic post-surgical pain in the groin region represents a challenge for the managing physician and is a burden on the quality of life of the patient. None of the existing interventions or medical treatment is satisfactory. Objectives: We aim to evaluate the analgesic efficacy of pulsed radiofrequency (PRF) applied to the ilioinguinal nerve and the genital branch of the genitofemoral nerve for patients suffering from chronic post-surgical orchialgia. Study Design: A prospective randomized, controlled clinical trial. Settings: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Seventy patients complaining of chronic post-surgical orchialgia were randomized into 2 groups: PRF group (n = 35), received pulsed radiofrequency on the ilioinguinal nerve and genital branch of the genitofemoral nerve, or sham group (n = 35). The percentage of patients that showed > 50 % reduction of their visual analog scale (VAS) pain score as well as the percentage of patients that did not require additional analgesic drugs was assessed. The VAS pain score and the global perceived effect (GPE) were reported during the 3-month follow-up period. Results: The percentage of patients that showed > 50% reduction of their VAS pain score was 80% (24/30) in the PRF group versus 23.33% (7/30) in the sham group. The percentage of patients that did not require analgesic drugs was 50% (15/30) in the PRF group versus 3.3% (1/30) in the sham group. There was a significant reduction of the mean post-procedural VAS pain score at 2, 4, 6, 8, and 12 weeks (P = 0.001) in the PRF group in comparison to the sham group. Likewise, there was a significant improvement of the GPE in the PRF group in comparison to the sham group (P = 0.00). Limitations: The study’s follow-up period was limited to 3 months only. Conclusions: For patients suffering from chronic post-surgical orchialgia, PRF applied to the ilioinguinal nerve and the genital branch of the genitofemoral nerve is an effective treatment modality. It provides long-lasting pain relief and decreases the demand for pain medications. Key words: Orchialgia, groin pain, radiofrequency, ilioinguinal nerve, genitofemoral nerve

Study objectiveThe objective of this study was to evaluate the effect of adding dexmedetomidine (DEX) to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia.DesignThis is a randomized, double-blind study.SettingThis study was performed in an educational and research hospital.PatientsOne hundred twenty adult males were scheduled for intrascrotal surgeries.InterventionsPatients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX) for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously.MeasurementsTime to first analgesic request, analgesic consumption, and visual analog scale (VAS) pain score in the first 24 hours postoperatively were assessed.Main resultsTime to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile) range, 7 (6–12) hours versus 6 (5–7) hours, (p=0.000), the mean cumulative morphine consumption (mg) in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI) of −4.57 (−6.06 to −3.07) (p=0.000); also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8), VAS 6 hours (2.62±1.5 vs 3.93±1.2), VAS 12 hours (2.40±1.1 vs 3.57±0.65), VAS 24 hours (1.90±0.68 vs 2.53±0.62) (p=0.000)ConclusionThe addition of 50 µg of DEX to bupivacaine 0.25% in spermatic cord block for intrascrotal surgeries resulted in delay of first analgesic supplementation, reduction of postoperative analgesic consumption as well as improvement of the success rate of the block.

Background: : Self-esteem is based on an individual's appraisal or estimation of his / her importance or value. Since infertility causes personal, familial, and social problems, it considered a devastating health problem. Infertile males experience considerable psychological stress, with low self esteem, isolation, loss of control, sexual inadequacy and depression. Objective: To assess impact of male infertility on self-esteem and determine relationship between clinical, demographic characteristics and self-esteem of infertile males. Patients and Methods: A non experimental (case-control) research design used to conduct this study. A purposive sample was used. The current study included 150 subjects, 100 was studied group & 50 was control group. Data collection tool consisted two parts:1-Demographic and clinical data sheet, 2-Modified form (Rosenberg Self-Esteem Scale (RSES). Results: The most of fertile and infertile age groups was from 28 to <38 years old. 65% of infertile males and 58% of fertile males were from rural area. About 63% of infertile males were primary infertility. As well as 56% of infertile males were 1-3 years. 74% of infertile males were smoked. There were highly statistically significant difference between level of self-esteem among infertile and fertile males (p=0.000**). Conclusion: From the present study, we can conclude that infertile males were having low self-esteem than fertile males making them more liable to having personal as well as social problems.