Said, S. Z., A. A. Awwad, M. A. Konsowa, and A. T. Motawi, Characteristics and management of testicular torsion patients presented to a tertiary care hospital: A prospective cohort study, , vol. 13, issue 13, pp. 1 - 7, 2023. AbstractWebsite

Background: Testicular torsion is a surgical emergency that occurs when twisting of the testicle around the spermatic cordtakes place. To our knowledge there are no regional manuscripts discussing testicular torsion.Aim: The current work aimed at filling this gap by studying the characteristics and management of patients presented withtesticular torsion.Patients and Methods: Study subjects were recruited from patients presented to Kasr Al-Ainy emergency departmentcomplaining of acute testicular pain for variable duration in a period of 6 months. A total of 33 patients were included.Results: The mean presenting age was 19.56 years (±6.94). Orchidectomy was done in 18 cases (54.5%) with the meanduration of torsion 6.43 hours ± 4.05. Orchidopexy was performed in 15 cases (45.4%) with the mean duration of torsion 28.56hours ± 11.08. There was a significant correlation between duration of torsion and fate of the testis. No statistically significantcorrelation between degree of torsion and fate of testis. In all cases, the type of torsion was intravaginal. Reactive hydrocelewas visualized in 15 patients, 11 of them (73.3%) underwent orchiopexy and 4 cases (26.7%) underwent orchiectomy. Nohydrocele could be visualized in 18 cases, 14 of them (77.8%) underwent orchiectomy and 4 cases (22.2%) underwentorchiopexy. A significant correlation was found between presence of reactive hydrocele and salvage of the testis.Conclusion: The time between the onset of pain and surgical intervention is the most important factor in prediction of the fateof the testis, in preoperative ultrasound, heterogeneity and absence of a reactive hydrocele were predictive factors of organloss but this is not a reason to delay surgery as some patients did not have.

Raheem, P. A. A., D. A. T. Motawi, D. T. M. Abdelraheem, D. S. Z. Saied, D. A. B. Tawfik, P. I. F. Soliman, P. H. M. Fahmy, and P. H. M. Ghanem, Efficacy of intracorporeal injections of allogenic platelet derived growth factors in the treatment of erectile dysfunction refractory to phosphodiesterase type 5 inhibitors, , vol. 19, issue 11, Supplement 4, pp. S9, 2022. AbstractWebsite

ObjectivesTo evaluate the effect of intracorporeal injections (ICI) of lyophilised growth factors (LGF) in patients with erectile dysfunction refractory to oral PDE5 inhibitors.
Methods
A single blind placebo-controlled study was carried out on 68 male participants (mean age 54.53 ± 7.78 years) conducted at one centre. Patients were divided into 2 groups (n=32 for each group). All participants underwent general and genital examination, evaluation of erectile function using an IIEF-5, SEP-2, SEP-3, erection hardness score (EHS) and pharmaco-penile duplex after an intra-corporeal injection of 20 mcg PGE1. The treatment group received an intracorporeal injection of 1 vial of LGF weekly for 4 weeks and the placebo group received 1 cc of saline weekly for 4 weeks. Follow-up was done by recording IIEF5 score, SEP 2 and 3, and GAQ 1 and 2 at 8 and 12 weeks post treatment as well as EHS and pharmaco-penile duplex study at 8 weeks post treatment.
Results
There was a statistically-significant improvement of the IIEF 5 score [(17.5 ± 3.11) in the treatment group vs (15.25 ± 1.01) in the control group, p<0.05], SEP 2 and 3, GAQ 1 and 2 positive responders 13 (40.6%) in the treatment group versus 1(3.1%) in the control group, and EHS in the treatment group [before injection there was no E3-4 response in the study population, after injection 15 out of 32 patients in the treatment showed improved response to ICI ranging from E3 to E4 while there were no patients who showed any improvement in the control group]. The results also showed a statistically-significant improvement in penile-duplex parameters (decreased right and left EDV in both sides). No local or systemic side effects were encountered.
Conclusions
ICI of LGF may improve penile haemodynamics, response to ICI, patient satisfaction, erectile function and may present a treatment option for patients with erectile dysfunction refractory to oral PDE5 inhibitors.
Conflicts of Interest
None

Abdelsalam, M., S. Zaki, M. S. Mousa, and A. Motawi, Effect of cigarette smoking on serum testosterone level among male smokers: a cross-sectional study, , vol. 70, pp. 124 - 127, 2020/08/24. Abstract
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sameh fayek gamalEl Din, A. T. Motawi, L. A. Rashed, H. Elghobary, H. M. Saad, M. M. Ismail, and H. F. Abdel-Latif, "Study of the role of microRNAs 16 and 135a in patients with lifelong premature ejaculation receiving fluoxetine daily for 3 months: A prospective case control study.", Andrologia, vol. 54, issue 10, pp. e14549, 2022. Abstract

We aimed to determine the level of miRNAs 16 and 135a in lifelong premature ejaculation (LPE) patients versus controls. Moreover, we evaluated the potential interplay between the studied miRNAs and fluoxetine in these patients after utilizing fluoxetine daily for 3 months. The study involved 60 consecutive LPE patients and 20 healthy age matched individuals as controls. The median miRNA16 was significantly higher in the controls (1.02) compared to the patients (0.31) (p < 0.001). Moreover, the median miRNA-135a was significantly higher in the controls compared to the patients 1.02 and 0.35, p < 0.001, respectively. In addition, the median pre-treatment miRNA16 in the responders was 0.29 that significantly increased to 0.66 (p < 0.001). The median pre-treatment miRNA-135a in the responders was 0.27 that significantly increased to 0.65 (p < 0.001). Furthermore, considering EXP(β) for the odds ratio evaluation, with a 95% degree of confidence, a 1 fold increase in pre-treatment miRNA 135a fold change decreases the odds for being responsive to SSRI by 0.028. Meanwhile, there was non-significant association between fluoxetine responsiveness and age, pre-treatment miRNA 16, pre-treatment PEDT and pre-treatment IELT. The current study had shown that a lower pre-treatment miRNA 135a was significantly associated with response to fluoxetine.

Said, S. Z., T. A. Nasser, M. Ayad, and A. T. Motawi, "Evaluation of the sensitivity of different doses of vasoactive drugs in diagnosing erectile dysfunction in impotent patients: a prospective case-control study.", Central European journal of urology, vol. 74, issue 1, pp. 109-115, 2021. Abstract

INTRODUCTION: Erectile dysfunction (ED) is one of the most common sexual disorders worldwide affecting about 30 million men in the United States, and an estimated 100 million men worldwide. Penile duplex doppler ultrasound (PDDU) is performed using an intracavernosal injection (ICI) of a vasoactive agent to demonstrate both arterial insufficiency and veno-occlusive dysfunction. This article aims to evaluate the sensitivity of different doses of different vasoactive agents used to diagnose ED in impotent patients.

MATERIAL AND METHODS: This study recruited 90 subjects with ED and 100 healthy subjects as controls. All of the subjects were assessed using the International Index of Erectile Function score (IIEF-5) while degree of erection was assessed by the Erection Hardness Score (EHS). Two penile duplex tests were done for each candidate two weeks apart.

RESULTS: None of the sample population achieved a normal clinical response (EHS >2) to 10 ug PGE1. In contrast, 60 controls (60%) had a normal response (EHS >2) to 10 ug PGE1. This difference in response between the sample and control populations to 10 ug PGE1 was of high statistical significance 11 (p <0.001). In contrast, 54 (60%) out of the 90 cases had normal clinical response (EHS >2) to 0.25cc Trimix (everywhere). Interestingly, 96 controls (96%) demonstrated normal response (EHS >2) to 0.25cc Trimix. This difference in response between the sample and control populations to 0.25 cc Trimix was also of high statistical significance (p <0.001).

CONCLUSIONS: Our study demonstrated a statistically significant association between the response to Trimix over PGE1 and peak systolic velocity (PSV) and end diastolic velocity (EDV). Thus, we conclude that 0.25 cc Trimix is more sensitive than 20 ug PGE1 in diagnosing ED for impotent patients and also provides a more potent response.

sameh fayek gamalEl Din, M. A. A. E. Salam, M. S. Mohamed, A. R. Ahmed, A. T. Motawaa, O. A. Saadeldin, and R. R. Elnabarway, "Tribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: A placebo-controlled study.", Urologia, vol. 86, issue 2, pp. 74-78, 2019. Abstract

Aging is associated with a series of morphological and functional modifications that leads to reduced physiological efficiency and atrophy of various organs and systems. Tribulus terrestris induces its effect in fertility and sexual functions through the steroidal saponins, particularly the dominant saponins protodioscin. We aimed in this study to evaluate the efficacy and safety profiles of Tribulus terrestris in aging males with partial androgen deficiency who suffered from erectile dysfunction and lower urinary tract symptoms. A total of 70 randomized aging patients with erectile dysfunction and lower urinary tract symptoms were recruited from June 2017 to March 2018 from our andrology outpatient clinic. Thirty-five patients (group A) received Tribulus terrestris three times daily for 3 months and the other 35 patients (group B) received placebo. The mean of aspartate transaminase was elevated in group A after 3 months of receiving Tribulus terrestris (26.5 (before), 27.8 (after), respectively, p = 0.03). Moreover, there were significant elevations in the means of both total testosterone together with the score of the validated Arabic index of erectile function (5-item version of the International Index of Erectile Function) (2.2, 10.7 (before), 2.7, 16.1 (after), p < 0.001, p < 0.001, respectively). Finally, the mean of the total prostate-specific antigen was elevated in this group (1.4 (before), 1.7 (before), p = 0.007, respectively). Interestingly, there were no worsening of the lower urinary tract symptoms in group A as there was no change in the mean score of the international prostate symptom score, which was used to assess these symptoms before and after treatment (mean 14.4 (before), 14.6 (after), p = 0.67, respectively). In sum, this study replicates the findings of previous reports about the robust effect of this herbal medicine in elevating the testosterone level and improving the sexual function of patients who suffered from erectile dysfunction with partial androgen deficiency.

Meliegy, A. E., A. Motawi, and M. A. A. E. Salam, "Systematic review of hormone replacement therapy in the infertile man.", Arab journal of urology, vol. 16, issue 1, pp. 140-147, 2018. Abstract

OBJECTIVES: To highlight alternative treatment options other than exogenous testosterone administration for hypogonadal men with concomitant infertility or who wish to preserve their fertility potential, as testosterone replacement therapy (TRT) inhibits spermatogenesis, representing a problem for hypogonadal men of reproductive age.

MATERIALS AND METHODS: We performed a comprehensive literature review for the years 1978-2017 via PubMed. Also abstracts from major urological/surgical conferences were reviewed. Review was consistent with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) criteria. We used Medical Subject Heading terms for the search including 'testosterone replacement therapy' or 'TRT' and 'male infertility'.

RESULTS: In all, 91 manuscripts were screened and the final number used for the review was 56. All studies included were performed in adults, were written in English and had an abstract available.

CONCLUSIONS: Exogenous testosterone inhibits spermatogenesis. Hypogonadal men wanting to preserve their fertility and at the same time benefiting from TRT effects can be prescribed selective oestrogen receptor modulators or testosterone plus low-dose human chorionic gonadotrophin (hCG). Patients treated for infertility with hypogonadotrophic hypogonadism can be prescribed hCG alone at first followed by or in combination from the start with follicle-stimulating hormone preparations.

Motawi, A., H. Ghanem, and I. Fathy, "SUPRAPUBIC FAT REDUCTION IN PATIENTS WITH HIDDEN PENIS", ASA 2016 annual meeting from April 2-5 USA, Astor Crowne Plaza New Orleans, Louisiana , USA, April 4, 2016. 2016_asa_visa_letter__motawi.pdf