Lotti, F., F. Frizza, G. Balercia, A. Barbonetti, H. M. Behre, A. E. Calogero, J. - F. Cremers, F. Francavilla, A. M. Isidori, S. Kliesch, et al., "The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: clinical, seminal and biochemical characteristics", Andrology, vol. 8, issue 5, pp. 1005-1020, 2020. 3_-the_european_academy_of_andrology_eaa_ultrasound_study.pdf
Shaeer, O., D. Skakke, A. Giraldi, E. Shaeer, and K. Shaeer, "Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women", J Sex Med, vol. 17, issue 6, pp. 1133-1143, 2020. 4-_female_orgasm_and_overall_sexual_function_and_habits.pdf
Shaeer, O., I. F. S. AbdelRahman, M. Mansour, and K. Shaeer, "Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation", J Sex Med, vol. 17, issue 7, pp. 1395-1399, 2020.
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Shaeer, O., K. Shaeer, and I. F. S. AbdelRahman, "Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion.", The journal of sexual medicine, vol. 16, issue 5, pp. 755-759, 2019. Abstract

INTRODUCTION: When a penile prosthesis is implanted, a fibrous tissue capsule gradually forms around it. In case of penile prosthesis infection, salvage and immediate reimplantation into the same capsule that envelops the infected prosthesis is a trial to avoid the difficulty and shortening encountered with explantation and delayed reimplantation.

AIM: We propose that, on salvage, the infected prosthesis be explanted, the capsule washed out and then abandoned, and the replacement prosthesis implanted in the extracapsular sinusoidal space, between the capsule and tunica albuginea. This aims at decreasing contact between the replacement implant and the pyogenic membrane in the capsule.

METHODS: This study was performed in a tertiary implantation center, involving 20 prospective cases referred with either an infected implant or pump erosion. Through a penoscrotal incision, lateral corporotomies were performed by superficial cuts, in a trial to identify the extracapsular sinusoidal space before opening the capsule. The capsule was then opened. All components of the implant were explanted, and the capsules were washed out. The extracapsular space within the corpora cavernosa was developed between the capsule and the tunica albuginea by sharp dissection initially, then bluntly dilated with a Hegar dilator. A malleable penile prosthesis was implanted in the extracapsular space bilaterally.

MAIN OUTCOME MEASURES: The reinfection rate was evaluated though 7-38 months after surgery.

RESULTS: We were able to identify and dilate the extracapsular space in 18 of 20 cases. Reinfection occurred in 1 case (1 of 18, 5.6%). Development of the extracapsular space added approximately 10 minutes to the operative time.

CLINICAL IMPLICATION: If salvage of an infected penile implant can be delayed until capsule maturation, extracapsular implantation may decrease the reinfection rate.

STRENGTH & LIMITATIONS: The limitations are the lack of a control group of intra-capsular classic salvage and the relatively limited sample number.

CONCLUSION: On penile prosthesis salvage surgery, whether for infection or extrusion, implantation of the replacement prosthesis in the extracapsular sinusoidal tissue is associated with low infection rates, because it bypasses the capsule, which may still harbor bacterial contamination despite the wash-out. Shaeer O, Shaeer K, AbdelRahman IFS. Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion. J Sex Med 2019;16:755-759.

Shaeer, O., I. F. S. AbdelRahman, and K. Shaeer, "Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants.", Sexual medicine, vol. 7, issue 3, pp. 357-360, 2019. Abstract

INTRODUCTION: In cases of explantation and delayed reimplantation of an infected penile prosthesis, the scarring that afflicts the corporal bodies renders reimplantation difficult and risky, with potential loss in penile size.

AIM: Mitomycin C is an antitumor, antibiotic agent with a potent antifibrotic action that can be used to limit corporal scarring following explantation with the aim of achieving easy and safe subsequent reimplantation, in addition to preserving penile size.

METHODS: This was a prospective study involving 5 patients with infected penile prostheses who were referred to our tertiary implantation center. The infected prostheses were explanted, followed by corporal washout with antiseptics and antibiotics. Patients were rescrubbed and redraped. Mitomycin C, 10 mg in 250 cc saline, was instilled into the corpora cavernosa (125 cc each), avoiding extracavernous spilling and contact with corporotomy and skin edges. Corporotomy and skin edges were freshened and closed. Reimplantation was performed 10 to 12 weeks later.

MAIN OUTCOME MEASURE: We evaluated the ease of blunt dilatation upon reimplantation and success in implanting cylinders the same size as the ones explanted.

RESULTS: We were able to dilate the corporal bodies with ease in all cases using blunt Hegar dilators. All cases received the same size implant as the one explanted, in terms of length and girth, with the exception of a case where the length was only 1 cm shorter.

CONCLUSIONS: Irrigation of the cavernous spaces with mitomycin C upon explantation of an infected penile prosthesis appears to ameliorate corporal scarring and keep the cavernous spaces open. On a larger scale, this approach could render the most feared complication of penile prosthesis implantation surgery much more manageable. Shaeer O, Abdel Rahman IFS, Shaeer K. Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants. Sex Med 2019; 7:357-360.

Shaeer, O. K. Z., "Shaeer's Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis.", Plastic and reconstructive surgery. Global open, vol. 4, issue 8, pp. e1019, 2016 Aug. Abstract

BACKGROUND: A concealed penis is a condition where part of the penis is invisible below the surface of the prepubic skin. Dermolipectomy can correct this condition, although it involves a long abdominal crease incision, or infrapubic incision around the base of the penis, and a possibility for genital lymphedema. This study describes Shaeer's technique, a minimally invasive method for revealing the concealed penis.

METHODS: A 1- to 2-cm-long incision was cut over the anterior superior iliac spine (ASIS) on either side. A long curved blunt forceps was inserted from one incision, down to the base of the penis and then up to the contralateral ASIS. A 5-mm wide nonabsorbable tape was picked up by the forceps from 1 incision and pulled through to emerge from the other. Pulling on the tape cephalad pulled the mons pubis and revealed the penis. The tape was sutured to the periosteum overlying the ASIS on either side. Patients were followed up for 18 months for penile length, complications, and overall satisfaction.

RESULTS: Twenty patients were operated upon. Preoperatively, flaccid visible length was 3 ± 0.9 cm, and erect visible length was 8 ± 4.6 cm. Postoperatively, the flaccid visible length was 7.1 ± 2.1 cm, with a 57.9% improvement in length (P < 0.0001). Erect visible length was 11.8 ± 2.1 cm, with a 32% improvement in length (P < 0.0001). Length gain was maintained for 18 months.

CONCLUSION: Shaeer's technique is a minimally invasive, short, and simple procedure for monsplasty and revealing the concealed penis.

Shaeer, O., and K. Shaeer, "Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique.", The journal of sexual medicine, vol. 15, issue 9, pp. 1350-1356, 2018 Sep. Abstract

BACKGROUND: Penile prosthesis implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, implantation is not possible.

AIM: This work presents extracorporeal transseptal implantation as a last resort in such cases.

METHODS: In 39 patients with extensive corporeal fibrosis, penile prosthesis implantation is attempted. After failure of alternative techniques, extracorporeal implantation is resorted to in 10 patients. The corpus spongiosum is identified and protected. Diathermy knife is used to cut a longitudinal window into 1 corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, halfway through. The 2 limbs of the rod are bent upward toward the glans, to assume a U shape. The limbs of the U are brought together at midshaft by a gathering suture passed through the corpora cavernosa and septum. The tips of the U are anchored under the glans.

OUTCOMES: Achievement of acceptable coital relationship.

RESULTS: The procedure allowed acceptable coital relationship and concealment in 9/10 cases. In 1 case, infection occurred. Reimplantation with the same method was performed 6 months later, and the implant survived adequately. Perforation, migration, and urethral injury were not encountered.

CLINICAL IMPLICATIONS: This technique may help salvage abandoned cases with corporal fibrosis, particularly when the necessary expertise for alternative techniques is unavailable or when such techniques fail.

STRENGTHS & LIMITATIONS: The technique presented is fairly straightforward and safe. However, the number of cases and duration of follow-up are limited.

CONCLUSION: Extracorporeal transseptal penile prosthesis implantation can salvage cases with severe corporeal fibrosis when all alternatives fail. Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018;15:1350-1356.

Shaeer, O., K. Shaeer, I. F. S. AbdelRahman, and A. Raheem, "Dorsal phalloplasty accompanying penile prosthesis implantation minimizes penile shortening and improves patient satisfaction.", International journal of impotence research, 2018 Oct 18. Abstract

Many patients complain of shortened length following penile prosthesis implantation. Dorsal phalloplasty (DP) can accompany prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient's body. DP is done through the same incision. A nonabsorbable suture approximates the under surface of the skin where the penis meets the pubis to the periosteum of the pubic bone. This adjunctive procedure results in more visible proximal penile shaft. We compared penile visible length (pubic skin surface to tip) in patients who had the adjunctive procedure with prosthesis insertion to patients who had only the penile prosthesis. Totally, 66 patients had DP and 60 did not. All patients were operated through a penoscrotal incision. The tacking suture of # 5 nonabsorbable braided polyester was passed through the pubic periosteum then into the subcutaneous tissue and dermis of the under surface of the pubic skin. The suture was tied after prosthesis insertion. Efficacy of DP was evaluated by measured gain in erect visible length in the DP group, maintenance of that length gain until final follow up at 3 years, as well as by the difference in subjective evaluation criteria between both groups. The DP group had a 23% increase in visible length compared to pretacking (p < 0.0001) that was durable to 36 months. Subjectively, 80% of patients in the prosthesis alone group reported a shorter penis in contrast to 6.1% in the DP group. The DP group reported 28.4% higher satisfaction with length, compared to the control group (p < 0.0001). In conclusion, DP accompanying prosthesis insertion improved visible length, minimized the impression of shortening, and enhanced satisfaction with length.

Shaeer, O. K. Z. M., K. Z. M. Shaeer, I. F. S. AbdelRahman, M. S. El-Haddad, and O. M. Selim, "Priapism as a result of chronic myeloid leukemia: case report, pathology, and review of the literature.", The journal of sexual medicine, vol. 12, issue 3, pp. 827-34, 2015 Mar. Abstract

INTRODUCTION: Priapism is rare-presenting feature in male patients with chronic myeloid leukemia (CML). Several hypotheses for pathogenesis have been described. Management has been controversial; some authors described resolution following priapism-specific interventions, and others recommended addition of CML-specific therapy or even CML-specific therapy alone.

AIM: In this report, we describe presentation and management of a man with refractory priapism that was the first presenting manifestation of CML. We also report, for the first time, the pathology sections of the sinusoidal tissue in such cases. Literature is reviewed for similar cases and their outcome.

METHODS: A 21-year-old male patient presented with painful priapism that started 6 days earlier and failed aspiration-irrigation. CBC revealed marked leucocytosis. Oncology care diagnosed CML, and treatment with Imatinib was commenced with prior semen cryopreservation. Following remission, a penile prosthesis was implanted, assisted by optical corporotomy. Sinusoidal tissue biopsy was stained by hematoxylin/eosin (H&E) and CD34.

MAIN OUTCOME MEASURES: Pathology sections of cavernous tissue following CML-induced priapism.

RESULTS: The penile implant survived without complications. H&E examination of the sinusoidal tissue biopsy revealed leukemic infiltration associated with vascular endothelial damage. CD34 staining showed the mixed picture of leukemic infiltrates, intact vascular endothelium with lumena showing leukemic cells, alternating with destroyed vessels, and no vascular lumena and ruminants of endothelial cells.

CONCLUSION: Priapism can be the first manifestation of previously undetected CML. The pathological picture of sinusoidal tissue in such cases is presented. In the case at hand, a complete blood picture was helpful in early diagnosis of CML and early initiation of targeted chemotherapy along with the corporal irrigation/aspiration or shunt surgery. It is therefore recommended to have a CBC examined at presentation of any case of ischemic priapism of unknown etiology, early initiation of CML therapy along with aspiration/irrigation, preferably cryopreserving a semen sample before CML therapy.