Andrology Department Research Articles

"A diamond-shaped" penoplasty technique with or without concurrent suprapubic liposuction for adult-acquired buried penis: clinical outcomes and patient satisfaction rates.

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m-2. In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.

Delayed covering causes the accumulation of motile sperm, leading to overestimation of sperm concentration and motility with a Makler counting chamber.

According to the World Health Organization (WHO) manual, sperm concentration should be measured using an improved Neubauer hemocytometer, while sperm motility should be measured by manual assessment. However, in China, thousands of laboratories do not use the improved Neubauer hemocytometer or method; instead, the Makler counting chamber is one of the most widely used chambers. To study sources of error that could impact the measurement of the apparent concentration and motility of sperm using the Makler counting chamber and to verify its accuracy for clinical application, 67 semen samples from patients attending the Department of Andrology, West China Second University Hospital, Sichuan University (Chengdu, China) between 13 September 2023 and 27 September 2023, were included. Compared with applying the cover glass immediately, delaying the application of the cover glass for 5 s, 10 s, and 30 s resulted in average increases in the sperm concentration of 30.3%, 74.1%, and 107.5%, respectively (all P < 0.0001) and in the progressive motility (PR) of 17.7%, 30.8%, and 39.6%, respectively (all P < 0.0001). However, when the semen specimens were fixed with formaldehyde, a delay in the application of the cover glass for 5 s, 10 s, and 30 s resulted in an average increase in the sperm concentration of 6.7%, 10.8%, and 14.6%, respectively, compared with immediate application of the cover glass. The accumulation of motile sperm due to delays in the application of the cover glass is a significant source of error with the Makler counting chamber and should be avoided.

Helicobacter pylori infection in psoriatic patients and its relation to psoriasis severity: Cross Sectional Study.

Psoriasis is a prevalent inflammatory skin condition that can be recognized by silvery-white scales on plaques and erythematous papules, despite the fact that psoriasis appears to have multiple causes. Helicobacter pylori (H. pylori) has been investigated recently as a potential infectious etiological component. The objective of the study was to evaluate the prevalence of H. pylori infection in psoriatic patients compared to that of healthy controls and determine whether the degree of psoriasis and H. pylori infection were related. The dermatology, venerology, and andrology department at South Valley University Outpatient Clinic carried out this cross-sectional study. Psoriatic patients of both sexes and ages were included. In addition to the control group, H. Pylori antigen was measured from psoriatic and control groups by using H. pylori stool antigen-enzyme linked immunosorbent assay (HpSA-ELISA), a test for H. pylori stool antigen. More than 20ng/mL of antigen proved positive, or less than 15ng/mL proved negative. There was a significant difference between psoriatic patients and control regarding H. pylori infection (p=0.046): (30.66%) positive in controls, (45.33%) positive in psoriatic patients. Both groups were matched for age (p=0.908), that is, the mean age of psoriatic patients was 37.44±15.79 years, and the control group was 37.15±15.15 years. Twenty-five psoriatic patients in each group: mild, moderate, and severe psoriasis according to the Psoriasis Area Severity Index (PASI) score. No significant correlation between H. pylori infection and PASI, age, or duration of illness in psoriatic patients. Patients with psoriasis had greater rates of H. pylori infection but didn't affect the severity of psoriasis.

Efficacy of Aphrodisiac Drugs Combination with Phosphodiesterase-5 (PDE5) Inhibitors in Patients with Erectile Dysfunction (Pilot Study)

Abstract Background Erectile dysfunction is a common medical disorder that primarily affects men older than 40 years of age. Many lines of treatments are used. An aphrodisiac is defined as any food or drug that arouses the sexual instinct, induces sexual desire and increases pleasure and performance. Aim of the Work The aim of this study to assess the efficacy of aphrodisiac drugs (Cavigen), in combination with Phosphodiesterase-5 (PDE5)”Sildenafil” Inhibitors in management of erectile dysfunction in men responding to Phosphodiesterase-5 (PDE5) inhibitors in patients with (IIEF) score: Mild (22-25), mild to moderate (17-21). Patients and Methods This study was a prospective, double-blind, case control placebo (pilot study) performed at the outpatient clinic of the Department of Urology and Andrology, Ain Shams University hospitals. The number of patients after the dropouts and exclusion were 40 patients, twenty in each group one group was administrated gingko biloba capsules(Cavigen) twice daily combined with phosphodiesterase 5 inhibitor (Viagra) on demand and the other one administrated placebo capsules similar to the ginkgo biloba twice daily combined with phosphodiesterase 5 inhibitor (Viagra) on demand. The study protocol was approved by our institutional review board. This study was performed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement and all participants provided written informed consent before nrolment. Patients were recruited from February 2020 to August 2020 and the final results were obtained in August 2020. Results The present study enrolled two well matched groups, twenty patients in each group as regard base line characteristics including demographic data, pretreatment IIEF total score and pretreatment type of ED. The present study enrolled two well matched groups and both groups showed improvement but there was no significant difference between the studied groups as regard IIEF total score and type of ED at one- and three- months posttreatment. After 6 months posttreatment there was significant difference between the studied groups as regard IIEF total score and type of ED with superiority of combined treatment group. The amount of increase in total score of IIEF after 6 months was found significantly higher in study group (6.35±3.38) than control group (2.15 ± 2.13) with p-value &amp;lt;0.001. In both of studied groups, we found that there was statistically significant increase in the total score of IIEF after 1 month, 3 months and 6 months than pre study and also increase in the percentage of no ED cases after 1 month, 3 months and 6 months than pre study. Conclusion Our findings demonstrate that two Ginkgo Biloba capsules oral intake per day combined with PDE-5 inhibitors on demand were safe and effective for the improvement of erectile function in patients with mild and mild to moderate ED. Overall, Aphrodisiacs drugs seem to be a promising cure for ED and improvement of sexual health.

Comparative Evaluation of Prostatic Smear and Semen Analysis in The Diagnosis of Chronic Prostatitis

Abstract Background Chronic prostatitis is one of the most common medical problems among andrology and urology patients. Besides being the primary problem in many cases, it seems to play an important contributing role “major or minor” in a significant proportion of patients whether at the level of fertility, sexology or venerology. Consequently, effective management of the prostatic pathology has a great impact on the overall successful management of such andrologic problem. Aim of the Work to provide an objective comparison between traditional prostatic discharge analysis and traditional semen analysis as regards detection of pus cells in cases of prostatitis as well as to assess the possible advantage(s) of applying some modifications to enhance the diagnostic value of the previous techniques. These would include preliminary centrifugation of expressed prostatic discharge and preliminary peroxidase staining of semen sample before microscopic examination. Patients and Methods This pilot study included 40 patients suffering from prostatitis except acute prostatitis. The patients were recruited from the outpatient clinic of Venerology and Andrology department of Ain Shams University Hospitals in the period from February 2021 to November 2021. Results The current study included 40 patients suffering from any kind of prostatitis except acute prostatitis. Their age ranged between 30 and 50 years old with a mean age of 39.60 ± 4.52 years. Duration of disease ranged from 4-18 months with a mean of 7 ± 3.1 months. Most of patients were married (38, 95%). Main symptoms presented among studied patients were groin pain (37.5%), groin pain and painful micturition (20%) and groin pain, painful micturition and sexual problems (42.5%) Conclusion prostatic smear examination revealed higher sensitivity in detection of infection compared to semen analysis especially if combined with centrifugation. In addition, peroxidase positive cell testing revealed a significant role in detection of infection if the diagnosis is made solely on semen analysis results.

Altered regional brain activity and functional connectivity in primary intravaginal anejaculation patients revealed by resting-state fMRI.

Ejaculation is regulated by the central nervous system. However, the central pathophysiology of primary intravaginal anejaculation (PIAJ) is unclear. The present study aimed to examine the changes in regional brain activity and functional connectivity underlying PIAJ. A total of 20 PIAJ patients and 16 healthy controls (HCs) were enrolled from September 2020 to September 2022 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Magnetic resonance imaging data were acquired from all participants and then were preprocessed. The measures of fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and functional connectivity (FC) were calculated and compared between the groups. PIAJ patients showed increased fALFF values in the left precuneus compared with HCs. Additionally, PIAJ patients showed increased ReHo values in the left precuneus, left postcentral gyrus, left superior occipital gyrus, left calcarine fissure, right precuneus, and right middle temporal gyrus, and decreased ReHo values in the left inferior parietal gyrus, compared with HCs. Finally, brain regions with altered fALFF and ReHo values in PIAJ patients showed increased FC with widespread cortical regions, which included the frontal, parietal, temporal, and occipital regions, compared with HCs. In conclusion, increased regional brain activity in the parietal, temporal, and occipital regions, and increased FC between these brain regions, may be associated with PIAJ occurrence.

(287) Influence of Severe Chronic Scrotal Pain on Men’s Sexual Activity: An Indication for Surgery?

Abstract Introduction Severe chronic scrotal pain significantly influences numerous aspects of a patient’s life and activities, particularly sexual activity. Objectives This study seeks to explore the clinical characteristics and the effects of chronic scrotal pain on male sexual activity, with a focus on patients with severe chronic scrotal pain who were candidates for microsurgical denervation of the spermatic cord. Methods This is an observational study that encompassed all patients with severe chronic scrotal pain who underwent microsurgical denervation of the spermatic cord at the Department of Andrology, Binh Dan Hospital, from January 1, 2022, to May 31, 2023, after other causes had been excluded. Results Thirty-one patients with chronic scrotal pain underwent surgery, with a mean age of 24.2 ± 4.3 years and a pain duration of 2.3 ± 1.6 years. Pain was located in the scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), and inguinal (15.1%), with postepididymitis (45.3%) being the predominant cause. The average Numerical Rating Scale (NRS) pain score before surgery was 6.8 ± 2.3. Thirteen out of thirty-one patients experienced severe pain (NRS = 7-10). The Quality of Life (QOL) scores were 6.75 ± 1.1 for patients with moderate pain and 4.6 ± 4.0 for those with severe pain. A smaller testicle size was observed in 43.5% of patients, and 51.6% had varicose veins on ultrasound, measuring 3.4 ± 1.2 mm. Sixteen out of thirty-one patients reported that scrotal pain impacted their sexual activity. Patients with higher pain scales (NRS 7-10) had significant effects on erectile function compared to those with moderate pain (P &amp;lt; 0.05). Decreased libido was reported in 34.1%, and lowered testosterone levels in 37.5% of the patient group. Sexual activity induced pain in 60.9% of cases, and the incidence of erectile dysfunction was significantly higher in the high pain scale group (P = 0.02). No significant statistical difference was observed between the duration of intercourse and the severity of scrotal pain. Conclusion Chronic scrotal pain, predominantly observed in young patients, has substantial impacts on the quality of life and sexual performance. Therefore, a meticulous consideration of sexual factors is imperative in male patients with chronic scrotal pain. Surgical indications for chronic scrotal pain treatment may be deemed necessary for sexual disorders associated with scrotal pain. Disclosure No.

(338) Impact of Microsurgical Denervation of the Spermatic Cord Treatment of Chronic Scrotal Pain on Men's Sexual Function: A Follow-Up Study for 6 Months After Surgical

Abstract Introduction When chronic severe scrotum affects the patient's activities and life in many aspects. Hypothetical study investigating clinical, laboratory characteristics and the influence of Microsurgical Denervation of the Spermatic Cord on male sexual performance. Objective The aim of this study was to describe the impact of microsurgical denervation of the spermatic cord treatment of chronic scrotal pain on men's sexual function Methods Observation study design. All patients with severe chronic scrotal pain, after excluding other causes, were indicated for surgery at the department of andrology, Binh Dan hospital from January 1, 2022 to November 1, 2022. Results There were thirty-one patients with chronic scrotal pain who underwent surgery. Mean age 24.2 ± 4.3 years, duration of pain 2.3 ±1.6 years. Location of pain: scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), inguinal (15.1%). Causes of pain: epididymitis (45.3%) accounted for most cases. NRS pain score before surgery 6.8 ± 2.3. There are 13/31 patients with severe pain scale (NRS = 7-10). Quality of life (QOL) in patients with moderate pain (NRS pain scale 1-6) 4.6 ± 4.0 and 6.75 ± 1.1 in patients with severe pain (NRS 7-10). 6%) patients reported pain affecting daily work Patient had small testicle size 43.5%, Varicose veins on ultrasound: 3.4±1.2 mm 51.6% (16/31) patients felt scrotal pain affecting sexual activity Patients with severe scrotal pain with high pain scale (NRS 7-10 points) had an effect on erectile function compared with moderate pain group (NRS 0-6 points) (P&amp;lt;0.05) Indicators “Scrotal pain prevents sexual activity”, “IIEF”, “Decreased libido ADAM questionnaire”, “Stimulating sexual activity pain”, “painful ejaculation” all improved after surgery. Conclusions Chronic scrotal pain mostly occurs in young patients with relatively large pain scores. Chronic scrotal pain also contributes to testicular size and endocrine function affecting quality of life. Chronic scrotal pain can greatly affect sexual performance in men. Microsurgical Denervation of the Spermatic Cord improves many aspects of a patient's sexual performance. Disclosure No.

Association between testosterone levels and RigiScan parameters of patients with erectile dysfunction.

It is difficult to diagnose hypogonadism because of the lack of objective assessments of erectile dysfunction (ED), which is caused by hypogonadism. To provide a new approach for diagnosing hypogonadism, this study evaluated the efficacy of nocturnal penile tumescence and rigidity (NPTR) testing with RigiScan for patients with ED with and without hypogonadism. From June 2021 to February 2023, 133 patients with ED (62 with hypogonadism and 71 without) underwent NPTR testing at the Department of Andrology. A detailed history of all participants was obtained. All participants also underwent a physical examination, sex hormone testing, and ultrasound examination of the cavernous vessels of the penis. Patient characteristics, sex hormone serum levels, and RigiScan Plus data of NPTR testing of patients with ED were obtained and evaluated. Between the groups, there were no significant differences in age, body mass index, or erectile function score or in the prevalence of smoking, drinking, diabetes, hypertension, and hyperlipidemia. RigiScan data revealed differences in erection episodes per night, average event rigidity, erection durations, and percentage of tumescence greater than baseline, which were significantly lower in the testosterone-deficient group than in the normal testosterone group. The average event rigidity of the tip displayed the largest area under the curve value, with a sensitivity of 67.6%, a specificity of 85.5%, and a cutoff value of 52.50. Our findings may allow appropriate patients to receive testosterone replacement therapy, which has been shown to be an effective treatment for hypogonadism. This is the first study of its kind to perform a comprehensive review of the association between hypogonadism and RigiScan parameters. This study was limited by its small sample size. RigiScan parameters of patients with ED and testosterone deficiency were significantly lower than those of patients with normal testosterone; therefore, RigiScan is useful for the differential diagnosis of patients with ED caused by hypogonadism.

Ambulatory Uretrocystoscopy in the Urology Andrology Department of Grand Mbour Hospital

Ambulatory Uretrocystoscopy in the Urology Andrology Department of Grand Mbour Hospital

Impact of Epididymal Sperm Aspiration on Microsurgical Vasoepididymostomy Outcomes in Patients with Obstructive Azoospermia-Report of 21 Cases Attached

ABSTRACT Background: To explore the impact of epididymal sperm aspiration on microsurgical vasoepididymostomy (MVE) outcomes in patients with obstructive azoospermia (OA). Methods: A retrospective analysis was conducted on 21 patients with OA who underwent epididymal sperm aspiration and received treatment at the department of andrology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from September 2016 to March 2023. Under microscopic scrutiny, the structure of the epididymis and any injuries to its ducts were observed and compared during MVE. Results: Microscopic analysis of 21 patients revealed notable changes in the appearance of the epididymis, showcasing substantial scar contracture and evident adhesion between the epididymal fascia and tunica vaginalis within the sheath, posing challenges in their separation. Among them, 12 patients exhibited fractured, shrunk, fibrotic, and semen-devoid epididymal ducts. Consequently, MVE could not be completed in 15 patients because of these factors, and only six patients underwent MVE. Among the patients who successfully underwent MVE, three patients had sperm in the follow-up examination 3 months after surgery, accounting for 50%. Conclusion: Epididymal sperm aspiration can damage the normal structure of the epididymis and epididymal duct, often leading to surgical termination during operation and a decrease in the long-term patency rate following surgery. Therefore, patients with OA are recommended to undergo MVE as the initial procedure. In case the surgery prove unsuccessful, epididymal or testicular sperm aspiration can be performed for intracytoplasmic sperm injection (ICSI) assisted reproduction. Additionally, patients with OA are advised to avoid diagnostic epididymal sperm aspiration.

The relationship between male semen parameters and sperm DNA fragment index with the age

To investigate the relationship between male semen parameters and sperm DNA fragment index with age. Adopt cross-sectional sampling survey design, 3 203 male patients who visited the Department of Reproductive Andrology in the Third Affiliated Hospital of Zhengzhou University from January 2019 to June 2021 were selected as subjects. Age range is 18-57 years, with the median age of 30 years. Through quartile regression analysis, the correlation between age and different male semen parameters and DNA fragment index (DFI) was presented. The study population was divided into ≤30 years old group and >30 years old group, and the correlation between age and semen volume, sperm concentration, total sperm count, progressive motility, total motility, percentage of normal sperm and DFI level were compared and analyzed. The results showed that there were significant differences in progressive motility, total motility and DFI level among different age groups (χ2=-4.608, -4.604, -7.719,P all <0.05), but there was no significant difference in semen volume, sperm concentration, total sperm count and percentage of normal sperm (χ2=-1.712, -1.203, -0.149, -0.175,P all >0.05). In the>30 years old age group, there was a very weak negative correlation between male age and semen volume, progressive motility and total motility (r=-0.137, -0.101 and -0.056, P all <0.05). There was a very weak positive correlation between male age and sperm concentration and sperm DFI level (r=0.061, 0.190, P all <0.05), while there was no correlation between male age and total sperm count and percentage of normal sperm (r=-0.018, -0.016,P all >0.05). In conclusion, with the increase of age, especially after the age of 30, semen volume, progressive motility and total motility decreased, while sperm concentration and DFI level increased, and semen quality decreased.

Efficacy and Safety of Diphenylcyclopropenone (DPCP) as a Depigmenting Therapy in Extensive Vitiligo

Abstract Background Patients with extensive vitiligo who have residual pigmentation affecting exposed areas especially acral sites or patients with vitiligo universalis often seek depigmentation. At present, there is no ideal depigmenting therapy available. Possible options include; monobenzyl ether of hydroquinone (MBEH) cream, phenol, cryotherapy and Q-switched lasers. Diphenylcyclopropenone (DPCP) has been reported to rarely cause vitiligo as a side effect during the treatment of alopecia areata. Aim The aim of the present work is to evaluate the efficacy and safety of DPCP as a depigmenting therapy in extensive Vitiligo. Patients and Methods This is a pilot single arm clinical trial study. Twenty patients with extensive vitiligo were recruited from the vitiligo outpatient clinic of Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. We used DPCP applied topically to residual pigmented patches (sensitization session then therapeutic sessions). Results Depigmentation occurred among 5 patients (25% of cases). Depigmentation occurred in different tested sites including the scalp, forearm and back. Itching and blister formation were the main side effects leading to intolerability to the DPCP treatment. Conclusion Cosmetic result of DPCP depigmentation was acceptable with no skin atrophy. Further studies could be done following other protocols using sensitization dose with less concentrations of DPCP to avoid patients' intolerance to the therapy.

Study of Effect of NB-UVB on Serum and Tissue Levels of CXCL9 in Vitiligenous Patients

Abstract Background CXCL 9 is a chemokine of Th1 which plays a significant role in the development of vitiligo. NB-UVB is an effective modality for treatment of vitiligo. Objective To finding whether NB-UVB can affect serum and tissue CXCL9 level or not. Patients and Methods The present study included 20 patients suffering from non-segmental vitiligo and 20 age- and sex- matched healthy controls, their age ranged from 18 to 65 years old, they were recruited from the outpatient clinic of Dermatology and Andrology Department in Ain Shams University Hospital during the period from May 2019 till December 2019. Results We evaluated disease severity by assessment of body surface area (BSA) of vitiligo disease in patients with calculation of VES score before NB-UVB and to evaluate patient improvement after treatment with NB-UVB we recalculated VES score after NB-UVB and calculated VES plus score. There was significant decrease in the surface area of the disease after treatment with NB-UVB than before. Conclusion The present study provides clinical data to support the role of CXCL9 in vitiligo particularly during the activity of the disease. Also our findings draw our attention to CXCL9 not only as a marker of disease activity, but also potentially as a marker of treatment response. So, targeting the IFN-γ-chemokine axis might be an effective treatment strategy.

Epidemiology of Psoriasis in Cairo Governorate

Abstract Background Psoriasis is a chronic, non-communicable, painful, disfiguring and disabling disease with great negative impact on patients’ quality of life (QoL). It can occur at any age, and is most common in the age group 50–69. Aim of the Study To identify the prevalence of psoriasis in Cairo governorate, the associated socio-demographic and anthropometric data, and percentage of each clinical type, as well as to define the possible precipitating factors and other diseases related to psoriasis. Patients and Methods This cross-sectional observational study included patients with psoriasis collected from patients attending the outpatient Dermatology and Andrology Department of Educational Hospitals of Cairo Governorate (Al Haud AlMarsoud Hospital &amp; Ain Shams University Hospital) during a period of six months that started from June 2020 to December 2020. It was a multi-center study including 2 Educational Dermatology hospitals. Results We found significant association between severity of psoriasis with male gender, with degree of impairment of life, with skin type III, and with higher age of onset. Conclusion We observed no association of psoriasis severity with DM, hypertension, BMI, or joint manifestations. Our findings are similar to most of other published epidemiological studies on psoriasis.

Serum folic acid: an effective indicator for arteriogenic erectile dysfunction.

The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery. A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED. After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824. Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED.

Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal

To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal. This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure. Forty-five (45) VVFs were identified over a period of 6years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13years with extremes of 13years and 75years; 17 patients (37.8%) were older than 45years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32years) (P=0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF. There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF. Level 4: retrospective study.

P-039 Pregnancy outcomes and genetic analysis of globozoospermic patients: A case series and review of the literature

Abstract Study question How should men with globozoospermia be managed in Assisted Reproductive Technologies (ART)? Summary answer IMSI (intracytoplasmic morphologically selected sperm injection), without oocyte activators (OA) allows to obtain a live birth, even when there is a mutation of DPY19L2 gene. What is known already Globozoospermia is a rare syndrome found in less than 0.1% of the infertile population. It is characterized by the presence of spermatozoa with round heads devoid of acrosomes. Two main genes are involved in the transmission of the disease: SPATA 16 and DPY19L2. Only Assisted Reproductive Technologies (ART) such as ICSI (intra-cytoplasmic sperm injection) and IMSI, with or without OA allow these couples to obtain pregnancies. There are no live births described after IMSI without OA in patients with a DPY19L2 mutation. Study design, size, duration Four infertile couples followed in the Department of ART at the Poissy Hospital Center, were studied between 2011 and 2022.All patients had total globozoospermia. Three patients were tested for the DPY19L2 gene mutation. Patients were managed in ART with the IMSI technique without the use of OA. Participants/materials, setting, methods The first patient had a homozygous mutation of the DPY19L2 gene. Two live births were obtained after IMSI. The second patient was not DPY19L2 mutated. 2 IMSI were performed, resulting in a biochemical pregnancy. The third patient had a homozygous mutation of the DPY19L2 gene. An IMSI was performed without obtaining a pregnancy, a second attempt is scheduled soon. The fourth patient refused genetic testing and IMSI management. Sperm donation was performed without achieving pregnancy. Main results and the role of chance In this case series, we present the management of four globozoosperm couples in the Reproductive Biology and Andrology Department at the Poissy Hospital Center. We also present the first two live births after performing an IMSI, without OA, in a globozoospermic patient with a homozygous mutation of DPY19L2 gene. In fact, according to our review of the literature, 53 case reports or articles of patients having benefited from ART with or without OA have been reported in globozoospermic patients. In these couples, 60 children were born. However, no live births had been reported until now in couples managed in IMSI without OA, where men had globozoospermia with DPY19L2 mutation. Limitations, reasons for caution The use of OA to increase the membrane permeability of oocyte to calcium and increase fertilization rates. The highest number of live births in the globozoosperm population occurs after ICSI or IMSI with OA. There is no described live birth without the use of OA in a DPY19L2 mutated patient. Wider implications of the findings The use of OA remains debated and is not authorized in some countries. Although our study found low fertilization rates after IMSI, it’s possible to obtain live births. The selection of spermatozoa with an acrosome outline at high magnification is thus an interesting alternative to the use of oocyte activators. Trial registration number not applicable

Seminal Calbindin 2 in Infertile Men With Varicocele: A Prospective Comparative Study

The present study compared seminal calbindin 2 (CALB 2) levels and semen parameters in men with and without varicocele. CALB 2 is also known as calretinin and 29 kDa calbindin. The study was a case-control study conducted from April (2021) to March (2022) in the andrology department at Beni-Suef University hospital. The study included four matched groups: group (I) were controls (fertile normozoospermic men without varicocele) (n=24). Group (II) were fertile normozoospermic men with varicocele (n=24). Group (III) were infertile oligoasthenoteratozoospermia (OAT) men without varicocele (n=24). Group (IV) were infertile OAT men with varicocele (n=24). The lowest levels of seminal CALB 2 were found in patients with severe oligozoospermia which showed a statistically significant difference when compared to seminal CALB 2 in patients with normal, mildly low, or moderately low sperm counts. There were significant negative correlations between sperm concentration, sperm motility and percentage of normal sperm forms and seminal CALB 2. Seminal plasma CALB 2 may play a role in the negative impact of varicocele on the semen parameters especially sperm concentration, sperm motility and percentage of sperm normal forms. Future studies are needed to verify these findings.

Recent modalities in treatment of telogen effluvium: Comparative study.

Telogen effluvium is one of the most common forms of diffuse, non-scarring hair loss for which patients present for clinical evaluation. It is usually a reactive and reversible disorder. Identifying and correcting the underlying cause is the most important component in management, yet there is always a need for therapeutic options. This study aims to evaluate the efficacy of single session botulinum toxin A injection versus multiple sessions of multivitamins mesotherapy in the treatment of telogen effluvium. A randomized clinical trial was conducted in the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twenty-four patients with telogen effluvium were randomly divided into two groups each group included 12 patients. Group I received a single session of Botulinum toxin A injection and group II received multiple sessions of multivitamins mesotherapy injection. Both botulinum toxin A and multivitamins mesotherapy are effective in the treatment of telogen effluvium, which was reflected on the improvement of hair parameters as terminal hair and multiple follicular units. Both treatment modalities had minimal and well-tolerated side effects. Although both therapies have equivalent success rates, single session of botulinum toxin A is a better choice than multiple mesotherapy sessions.