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2018
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.

2016
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.

2015
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.

2014
Shaeer, O., and K. Shaeer, "Same-session dorsal vein ligation and testing by intracavernous injection prior to penile prosthesis implantation (DVL-ICI-PPI).", The journal of sexual medicine, vol. 11, issue 9, pp. 2333-7, 2014 Sep. Abstract

INTRODUCTION: Complications of penile prosthesis implantation (PPI) are rare, nevertheless can be grave. In cases with veno-occlusive dysfunction (VOD), alternative surgical techniques such as dorsal vein ligation (DVL) are controversial. Some patients may opt for trial at DVL to avoid the possible complications of PPI. However, this may be associated with disappointment if DVL fails and another procedure is required.

AIM: The aim if this study is to evaluate the results of a combined approach involving DVL, same-session testing by intracavernous injection (ICI) of prostaglandin E1 (PGE1), and immediate implantation of a penile prosthesis (PPI) in case of poor response to DVL.

MAIN OUTCOME MEASURES: Long-term erectile function in cases with favorable intraoperative response to DVL.

METHODS: Twenty-six patients with refractory VOD were operated upon. Through a peno-pubic incision, DVL was performed, followed by ICI of 20 µg PGE1 in two divided doses, 10 µg each, 15 minutes apart. Group 1 exhibited full rigidity in response to the first dose. Group 2 exhibited full rigidity in response to the second dose. PPI was not performed for either. Group 3 exhibited suboptimal response to both doses, and PPI was performed through the same incision. Patients were followed up from 24 to 48 months using International Index of Erectile Function-5 scoring.

RESULTS: For Group 1 (n = 8), six patients experienced normal erectile function following DVL throughout the whole follow-up period of 48 months (23.1% of all patients), and two patients relapsed. Group 2 (n = 6) (23.1%) reported normal erectile function for an average of 6 months, then relapsed. Group 3 (n = 12) had a penile prosthesis implanted in the same setting.

CONCLUSION: Combined DVL-ICI-PPI can spare around 23.1% of young patients with VOD from PPI, at no additional risk. Full response to 10 µg PGE1 at intraoperative testing carries good prognosis to DVL on the long run. Investigation of a larger number of patients is necessary before reaching a final conclusion.

Shaeer, O., and K. Shaeer, "The Global Online Sexuality Survey (GOSS): male homosexuality among Arabic-speaking internet users in the Middle East--2010.", The journal of sexual medicine, vol. 11, issue 10, pp. 2414-20, 2014 Oct. Abstract

INTRODUCTION: The prevalence of male homosexuality is difficult to elicit considering the sensitivity of one's sexual orientation. The Global Online Sexuality Survey (GOSS) is an online epidemiologic study of male and female sexuality. The online nature of GOSS allows more confidentiality and wider geographic reach, particularly important in investigating sexual issues within the more conservative societies.

AIM: This study aims to determine the prevalence of male homosexuality among Internet users in the Arabic-speaking Middle East and the unique characteristics of this subset of the population.

MAIN OUTCOME MEASURES: Prevalence of male homosexuality.

METHODS: In the year 2010, GOSS was offered to Arabic-speaking web surfers above 18 years of age in the Middle East. Potential participants were invited via advertising on Facebook®. Invitations were dispatched randomly with the exception of geographic region and age, regardless web surfing preferences. GOSS relied in part on validated questionnaires such as the International Index of Erectile Function, as well on other nonvalidated questions.

RESULTS: 17.1% reported desire toward the same sex, of whom 5.6% had homosexual encounters, mostly in the form of external stimulation rather than intercourse, and exclusively undercover. An overwhelming majority was ego-dystonic (78.2%).

CONCLUSION: This is--to our knowledge--the first online survey to address the prevalence of homosexual orientation and practice in the Middle East, discriminating desire from practice, ego-syntonic from ego-dystonic, and investigating the pattern of practice. Homosexual desire is present in the Middle East as it is around the world, and homosexual encounters are as prevalent. Yet, the undercover and ego-dystonic states prevail.

Shaeer, O., "Girth augmentation of the penis using flaps "Shaeer's augmentation phalloplasty": the superficial circumflex iliac flap.", The journal of sexual medicine, vol. 11, issue 7, pp. 1856-62, 2014 Jul. Abstract

INTRODUCTION: Penile girth augmentation can be achieved by various techniques, among which are liposuction injection, synthetic grafts, and autologous grafts, with variable outcome, mostly related to viability and receptivity of the tissue used for augmentation. Flaps are considered superior to grafts considering their uninterrupted blood supply.

AIM: The current work describes long-term experience with penile girth augmentation using the superficial circumflex iliac artery and vein (SCIAV) flap.

METHODS: SCIAV flap was used for penile girth augmentation in 40 candidates who followed up for a minimum of 18 months. The flap was mobilized from the groin region. The penis was pulled out of a peno-pubic incision. The flap was tunneled under the pubic region to emerge at the base of the penis and was sutured to the subcoronal area and on either sides of the spongiosum. Another session was required for either de-bulking of the oversized flap (four overweight candidates), flap pedicle (n = 6), or for donor site scar revision (n = 11).

MAIN OUTCOME MEASURES: Gain in girth in centimeters was evaluated.

RESULTS: Excluding dropouts (n = 8) and participants who had encountered de-bulking of the flap body (n = 4), 40 participants had a preoperative average flaccid girth (AFG) of 9.3 ± 1.1 cm. Immediately postoperative AFG was 14.9 ± 1.1 cm (P < 0.001). Postoperative AFG at the final follow-up visit (a minimum of 18 months) was 14.5 ± 1.1 cm (55.6% gain compared with baseline, P < 0.001).

CONCLUSION: SCIAV flap is a reliable option for long-lasting and sizable penile girth augmentation. One-stage augmentation is more suited for non-obese candidates. A second session may be indicated in overweight candidates or for scar revision.

Shaeer, O., "Skin reduction technique for correction of lateral deviation of the erect straight penis.", The journal of sexual medicine, vol. 11, issue 7, pp. 1863-6, 2014 Jul. Abstract

INTRODUCTION: Lateral deviation of the erect straight penis (LDESP) refers to a penis that despite being straight in the erect state, points laterally, yet can be directed forward manually without the use of force. While LDESP should not impose a negative impact on sexual function, it may have a negative cosmetic impact.

AIM: This work describes skin reduction technique (SRT) for correction of LDESP.

METHODS: Counseling was offered to males with LDESP after excluding other abnormalities. Surgery was performed in case of failed counseling. In the erect state, the degree and direction of LDESP were noted. Skin on the base of the penis on the contralateral side of LDESP was excised from the base of the penis and the edges approximated to correct LDESP. Further excision was repeated if needed. The incision was closed in two layers.

MAIN OUTCOME MEASURE: Long-term efficacy of SRT was the main outcome measure.

RESULTS: Out of 183 males with LDESP, 66.7% were not sexually active. Counseling relieved 91.8% of cases. Fifteen patients insisted on surgery, mostly from among the sexually active where the complaint was mutual from the patient and partner. SRT resulted in full correction of the angle of erection in 12 cases out of 15. Two had minimal recurrence, and one had major recurrence indicating re-SRT.

CONCLUSIONS: LDESP is more common a complaint among those who have not experienced coital relationship, and is mostly relieved by counseling. However, sexually active males with this complaint are more difficult to relieve by counseling. A minority of patients may opt for surgical correction. SRT achieves a forward erection in such patients, is minimally invasive, and relatively safe, provided the angle of erection can be corrected manually without force. Shaeer O. Skin reduction technique for correction of lateral deviation of the erect straight penis.

2013
Shaeer, O., "The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III--Premature ejaculation among English-speaking male Internet users.", The journal of sexual medicine, vol. 10, issue 7, pp. 1882-8, 2013 Jul. Abstract

INTRODUCTION: The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders. In 2010, the first report of GOSS came from the Middle East.

AIM: This report studies the prevalence rate of premature ejaculation (PE) in the U.S. as of 2011-2012 and evaluates risk factors for PE.

METHODS: GOSS was randomly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook®, comprising 146 questions.

MAIN OUTCOME MEASURES: Prevalence of PE as per the International Society of Sexual Medicine's (ISSM) definition.

RESULTS: With a mean age of 52.38 years ± 14.5, 1,133 participants reported on sexual function. As per the ISSM definition of PE, the prevalence rate of PE in the USA as of 2011 was 6.3%. This is in contrast to 49.6% as per the Premature Ejaculation Diagnostic Tool (PEDT), 77.6% as per unfiltered subjective reports, and 14.4% as per subjective reporting on more consistent basis. 56.3% of the latter reported lifelong PE. 63.2% could be classified as having natural variable PE. Erectile dysfunction is a possible predisposing factor for acquired PE, while genital size concerns may predispose to lifelong PE. Age, irregular coitus, circumcision, and the practice of masturbation did not pose a risk for PE, among other risk factors. Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics, particularly in those with lifelong PE.

CONCLUSION: Applying the ISSM definition, prevalence of PE is far less than diagnosed by other methods, 6.3% among Internet users in USA as of the year 2011. PEDT measures both lifelong and acquired PE, in addition to 35% men with premature-like ejaculatory dysfunction, making it inaccurate for isolating lifelong and acquired PE cases.

Shaeer, O., "The Global Online Sexuality Survey (GOSS): the United States of America in 2011 chapter II: phosphodiesterase inhibitors utilization among English speakers.", The journal of sexual medicine, vol. 10, issue 2, pp. 532-40, 2013 Feb. Abstract

INTRODUCTION: Utility of phosphodiesterase inhibitors (PDEi's) for the treatment of erectile dysfunction (ED) has been the focus of experimental and clinical studies. However, public preferences, attitudes, and experiences with PDEi's are rarely addressed from a population/epidemiology viewpoint. The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, first launched in the Middle East in 2010, followed by the United States in 2011.

AIM: To describe the utilization rates, trends, and attitudes toward PDEi's in the United States in the year 2011.

METHODS: GOSS was randomly deployed to English-speaking male Web surfers in the United States via paid advertising on Facebook®, comprising 146 questions.

MAIN OUTCOME MEASURES: Utilization rates and preferences for PDEi's by brand.

RESULTS: Six hundred three subjects participated; mean age 53.43 years ± 13.9. Twenty-three point seven percent used PDEi's on more consistent basis, 37.5% of those with ED vs. 15.6% of those without ED (recreational users). Unrealistic safety concerns including habituation were pronounced. Seventy-nine point six percent of utilization was on prescription basis. PDEi's were purchased through pharmacies (5.3% without prescription) and in 16.5% over the Internet (68% without prescription). Nine point six percent nonprescription users suffered coronary heart disease. Prescription use was inclined toward sildenafil, generally, and particularly in severe cases, and shifted toward tadalafil in moderate ED and for recreational use, followed by vardenafil. Nonprescription utilization trends were similar, except in recreational use where sildenafil came first.

CONCLUSION: In the United States unrealistic safety concerns over PDEi's utility exist and should be addressed. Preference for particular PDEi's over the others is primarily dictated by health-care providers, despite lack of guidelines that govern physician choice. Online and over-the-counter sales of PDEi's are common, and can expose a subset of users to health risks. Recreational use of PDEi's is common, and could be driven by undiagnosed premature ejaculation.

Shaeer, O., and E. Shaeer, "The Global Online Sexuality Survey: public perception of female genital cutting among internet users in the Middle East.", The journal of sexual medicine, vol. 10, issue 12, pp. 2904-11, 2013 Dec. Abstract

INTRODUCTION: Female genital cutting (FGC) is a ritual involving cutting part or all of the female external genitalia, performed primarily in Africa. Understanding the motivation behind FGC whether religious or otherwise is important for formulating the anti-FGC messages in prevention and awareness campaigns.

AIM: The study aims to provide an investigation of opinion over FGC, the root motive/s behind it, in addition to the current prevalence of FGC among Internet users in the Middle East.

METHODS: The Global Online Sexuality Survey was undertaken in the Middle East via paid advertising on Facebook®, comprising 146 questions.

MAIN OUTCOME MEASURES: The main outcomes are the prevalence of and public opinion on FGC among Internet users.

RESULTS: 31.6% of 992 participants experienced FGC at an average age of 9.6 ± 3.5 years, mostly in Egypt (50.2%). FGC was performed among both Muslims (36.9%) and Christians (18.8%), more in rural areas (78.7%) than urban (47.4%), and was performed primarily by doctors (54.7%) and nurses (9.5%). Whether or not it is necessary for female chastity, FGC was reported as highly necessary (22.5%), and necessary (21.6%). This was more among males, particularly among those with rural origin, with no difference as per educational level. This is in contrast to only 3.7% regarding FGC as a mandate of Islam. Religious opinion among Muslims was: 55.4% anti-FGC and 44.6% pro-FGC.

CONCLUSION: An important motivation driving FGC seems to be males seeking female chastity rather than religion, especially with FGC not being an Islamic mandate, not to undermine the importance of religion among other motives. School and university education were void of an effective anti-FGC message, which should be addressed. There is a shift toward doctors and nurses for performing FGC, which is both a threat and an opportunity. We propose that the primary message against FGC should be delivered by medical and paramedical personnel who can deliver a balanced and confidential message.

Shaeer, O., and E. Shaeer, "The Global Online Sexuality Survey: Public Perception of Female Genital Cutting among Internet Users in the Middle East", J Sex Med, 2013. AbstractWebsite

INTRODUCTION: Female genital cutting (FGC) is a ritual involving cutting part or all of the female external genitalia, performed primarily in Africa. Understanding the motivation behind FGC whether religious or otherwise is important for formulating the anti-FGC messages in prevention and awareness campaigns. AIM: The study aims to provide an investigation of opinion over FGC, the root motive/s behind it, in addition to the current prevalence of FGC among Internet users in the Middle East. METHODS: The Global Online Sexuality Survey was undertaken in the Middle East via paid advertising on Facebook(R), comprising 146 questions. MAIN OUTCOME MEASURES: The main outcomes are the prevalence of and public opinion on FGC among Internet users. RESULTS: 31.6% of 992 participants experienced FGC at an average age of 9.6 +/- 3.5 years, mostly in Egypt (50.2%). FGC was performed among both Muslims (36.9%) and Christians (18.8%), more in rural areas (78.7%) than urban (47.4%), and was performed primarily by doctors (54.7%) and nurses (9.5%). Whether or not it is necessary for female chastity, FGC was reported as highly necessary (22.5%), and necessary (21.6%). This was more among males, particularly among those with rural origin, with no difference as per educational level. This is in contrast to only 3.7% regarding FGC as a mandate of Islam. Religious opinion among Muslims was: 55.4% anti-FGC and 44.6% pro-FGC. CONCLUSION: An important motivation driving FGC seems to be males seeking female chastity rather than religion, especially with FGC not being an Islamic mandate, not to undermine the importance of religion among other motives. School and university education were void of an effective anti-FGC message, which should be addressed. There is a shift toward doctors and nurses for performing FGC, which is both a threat and an opportunity. We propose that the primary message against FGC should be delivered by medical and paramedical personnel who can deliver a balanced and confidential message. Shaeer O and Shaeer E. The Global Online Sexuality Survey: Public perception of female genital cutting among Internet users in the Middle East. J Sex Med **;**:**-**.

2012
Shaeer, O., "Congenital penile drop: defective suspensory ligament versus severe proximal curvature, a case series.", The journal of sexual medicine, vol. 9, issue 2, pp. 618-24, 2012 Feb. Abstract

INTRODUCTION: Penile drop is a condition where the erect penis is pointing downward. It can either be congenital or posttraumatic. Congenital cases can be attributed to either a defective penile suspensory ligament (PSL) or severe congenital curvature, with the point of maximum curvature proximal, at the base of the penis, concealed within the pubic fat (proximal penile curvature [PPC]). It is important to diagnose the underlying abnormality and choose the surgical approach accordingly, considering that surgical correction of PSL defects results in shortening that can be avoided in PPC cases.

AIM: This work describes a method for discriminating PSL defects from PPC and their surgical management.

MAIN OUTCOME MEASURES: Accuracy of preoperative diagnosis and results of surgery in terms of erection angle and penile length.

METHODS: This is a retrospective study of the management of 12 male patients with congenital penile drop. Diagnostic measures were the pubic gap sign: palpation of a gap between the pubis and the penis, the straightening sign: patients with PSL defects can correct the angle of erection while contrary to PPC cases, Sexual Health Inventory for Men (SHIM), and intraoperative trial rotation of the corpora cavernosa that will correct PPC cases and point them out. Accordingly, PSL cases were managed by anchoring the base of the penis to the pubis, while PPC cases were managed by corporal rotation.

RESULTS: Penile drop was fully corrected with shortening in PSL group and without in the PPC group. The straightening sign, SHIM, and trial rotation were in agreement contrary to the pubic gap sign.

CONCLUSION: Discriminating PSL defects from PPC is possible by the combination between "straightening sign" and SHIM results. PSL cases should be managed by anchoring sutures despite the inevitable shortening. PPC cases can be spared the shortening by corporal rotation.

Shaeer, O., and K. Shaeer, "The Global Online Sexuality Survey (GOSS): ejaculatory function, penile anatomy, and contraceptive usage among Arabic-speaking Internet users in the Middle East.", The journal of sexual medicine, vol. 9, issue 2, pp. 425-33, 2012 Feb. Abstract

INTRODUCTION: Sexuality is a sensitive issue that may be difficult to explore through surveys involving direct contact. Epidemiological studies in this domain are scarce. Online surveys may provide more anonymity and less direct contact encouraging participation. The Global Online Sexuality Survey (GOSS) reports on different aspects of male and female sexuality. The Global Online Sexuality Survey-Arabic-Males (GOSS-AR-M) is the Arabic version reporting on male sexuality.

AIM: To evaluate male ejaculatory function, penile size and contraceptive trends among Arabic speakers in the Middle East.

METHODS: The survey was randomly offered online to web surfers in the Middle East.

MAIN OUTCOME MEASURES: Prevalence of premature ejaculation, ejaculatory latency, penile size and their correlation with erectile function.

RESULTS: A total of 82.6% reported various degrees of premature ejaculation, associated with a statically significant decline in erectile function, despite a median intravaginal ejaculatory latency time (IELT) of 5 minutes, 95% confidence interval (CI) of 8.4-9.8. Adjusted to the World Standard Population by the World Health Organization, the collective prevalence was 83.7%. Local anesthetics gave better results and tolerance in delaying ejaculation. Self-measured erect penile length from symphysis pubis to glans was 15.6 cm ± 4.1, 95% CI = 15.4-15.9, yet, 30% were dissatisfied with size, mainly in the flaccid state, with dissatisfaction being inversely proportional with erectile function. Intrauterine device was the method mostly used by couples, and condoms had a high dissatisfaction rate.

CONCLUSION: The prevalence of premature ejaculation appears to surpass that of erectile dysfunction, despite the possibility that it may be overreported considering the acceptable IELT of the population surveyed. Premature ejaculation and concerns over genital size may be considered as risk factors for ED. More male contraceptive measures should be introduced and popularized. Alleviating dissatisfaction with condom utility via health education should be a priority.

Shaeer, O., K. Shaeer, and E. Shaeer, "The Global Online Sexuality Survey (GOSS): female sexual dysfunction among Internet users in the reproductive age group in the Middle East.", The journal of sexual medicine, vol. 9, issue 2, pp. 411-24, 2012 Feb. Abstract

INTRODUCTION: The exact prevalence of female sexual dysfunction (FSD) in the Middle East is exceptionally difficult to measure in light of its sensitive nature and the conservative tinge of the population.

AIM: The Global Online Sexuality Survey-Arabic-Females (GOSS-AR-F) is a community-based study of female sexuality in the Middle East through an online survey.

MAIN OUTCOME MEASURES: Prevalence of risk for female sexual dysfunction (rFSD) in the reproductive age group and its vulnerability to various risk factors.

METHODS: GOSS-AR-F was offered via online advertising. The survey is comprised of the Female Sexual Function Index (FSFI) questionnaire among other questions.

RESULTS: Out of 2,920 participants, 344 participants completed all survey questions. Average total FSFI score was 23 ± 6.5, with 59.1% of participants suffering rFSD. Age adjusted prevalence of rFSD was 59.5%, standardized to World Health Organization World Standard Population. There was a statistically significant higher prevalence of rFSD among cases with subjectively reported depression and male partner-related shortcomings such as erectile dysfunction and premature ejaculation as reported by the female participant, in addition to dissatisfaction with partner's penile size, insufficient foreplay, and practice of masturbation. This was not the case with advancing age, diabetes mellitus, hypertension, smoking, ongoing pregnancy, mode of previous child delivery, infertility, menstrual irregularities, dysmenorrhea, interpersonal distress, subjectively reported hirsutism, and female genital cutting. Participants were found to require longer duration of coitus and better ejaculatory control but not necessarily a higher coital frequency.

CONCLUSION: Female sexual function in the reproductive age appears to be adversely affected by psychological factors and shortcomings in male sexual function more than anything. These findings point to the possibility that many cases of FSD can be managed with the focus on male partner's ailments and attitudes that are relatively easier to manage.

Shaeer, O., and K. Shaeer, "The Global Online Sexuality Survey (GOSS): the United States of America in 2011. Chapter I: erectile dysfunction among English-speakers.", The journal of sexual medicine, vol. 9, issue 12, pp. 3018-27, 2012 Dec. Abstract

INTRODUCTION: The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%.

AIM: This report studies the prevalence rate of ED in the United States as of 2011-2012 and evaluates risk factors for ED.

MAIN OUTCOME MEASURES: Prevalence of ED.

METHODS: GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function.

RESULTS: Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was.

CONCLUSION: Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.

Shaeer, O., "Shaeer's glans augmentation technique: a pilot study.", The journal of sexual medicine, vol. 9, issue 12, pp. 3264-9, 2012 Dec. Abstract

INTRODUCTION: Augmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of hyaluronic acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation.

AIM: This work is the first report on glans augmentation by grafting.

MAIN OUTCOME MEASURES: Maximum circumference of the glans, self-reported impression of the augmented volume and glans sensitivity.

METHODS: Ten males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either side. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures.

RESULTS: Maximum circumference of the glans increased by 16.6%, declining to 14.2% by the last follow-up visit (10-12 months), a 2.3% decline. Self-reported impression of the augmented volume was high and well maintained over the follow-up period. Glans sensation, engorgement, erectile function, and ejaculatory control were preserved.

CONCLUSION: This pilot study on glans augmentation by grafting reports promising results with retention of the added volume at 1-year follow-up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.

Shaeer, O., and K. Shaeer, "Impact of penile size on male sexual function and role of penile augmentation surgery.", Current urology reports, vol. 13, issue 4, pp. 285-9, 2012 Aug. Abstract

Penile augmentation is an ongoing debate. Emerging evidence proves a relationship between dissatisfaction with penile size and sexual dysfunction. Despite a widespread belief of the value of penile size, and the prevalent complaint of a "small penis," penile augmentation still stands short of addressing the demand. This report highlights the studies added to medical literature on penile augmentation in 2011-2012, including data on normal penile dimensions and the expected dimensions for a normal person, determination of the prevalence of the dissatisfaction with penile size, its effect on erectile function, female partner's opinion of the value of penile size, as well as further experience with augmentation techniques.

2011
Shaeer, O., "Trans-corporal incision of Peyronie's plaques.", The journal of sexual medicine, vol. 8, issue 2, pp. 589-93, 2011 Feb. Abstract

INTRODUCTION: Patients presenting with Peyronie's disease (PD) curvature and erectile dysfunction (ED) can achieve straightening and rigidity through penile prosthesis implantation and manual modeling and, if necessary, a relaxing tunical incision with or without grafting. Unfortunately, this maneuver will not correct PD-induced shortening. In addition, incision and grafting after the prosthesis has already been implanted adds to operative time and risk, and may indicate mobilization of the neurovascular bundle and, possibly, a secondary skin incision.

AIM: This work describes trans-corporal incision (TCI), a minimally invasive endoscopic approach for plaque incision from within the corpora cavernosa, restoring straightness and length to the penis, before calibration of the corpora cavernosa, allowing implantation of a longer prosthesis in a straight penis, with neither mobilizing the neurovascular bundle nor a secondary incision.

METHODS: Sixteen patients with PD deformity and refractory ED were operated upon. Intra-operative artificial erection demonstrated the deformity. Through a penoscrotal incision, the corpora were dilated. TCI was performed to incise Peyronie's plaques at the point of maximum deformity. Artificial erection was re-induced and correction of curvature evaluated. Length was measured before and after TCI. Implantation proceeded as usual.

MAIN OUTCOME MEASURES: Penile straightness and length.

RESULTS: Following implantation, the penis was straight in all cases. Pre-TCI length of the corpora was unequal on either side. Post-TCI, both corpora were of equal length with an average increase of 2.5 cm (11.9%) on the right side and 1.9 (9.1%) on the left.

CONCLUSION: TCI; corporoscopic incision of Peyronie's plaques upon implantation of penile prosthesis is a minimally invasive approach that restores both straightness and length to patients with PD and ED, with neither mobilization of the neurovascular bundle nor plaque incision and grafting.

Shaeer, O., and K. Shaeer, "The Global Online Sexuality Survey (GOSS): erectile dysfunction among Arabic-speaking internet users in the Middle East.", The journal of sexual medicine, vol. 8, issue 8, pp. 2152-60; quiz 2160-3, 2011 Aug. Abstract

INTRODUCTION: Epidemiologic studies exploring sexuality across different cultures and geographic regions are scanty, particularly from the Middle East. The Global Online Sexuality Survey (GOSS) is an Internet-based survey investigating male and female sexual function. GOSS-Arabic-Males is the Arabic version targeting males in the Middle East, exploring prevalence rate of and factors affecting erectile dysfunction and its therapeutic trends, as well as premature ejaculation, attitudes toward genital size, and contraception.

AIM: To explore epidemiologic aspects of male sexuality through an online survey.

MAIN OUTCOME MEASURES: Prevalence rate of erectile dysfunction, its relationship to risk factors, and therapeutic trends.

METHODS: The online survey was randomly offered to Web surfers in the Middle East.

RESULTS: Eight hundred four subjects completed the survey. The overall prevalence of ED was 45.1%, strongly correlating with various risk factors studied, including age, diabetes, hypertension under treatment, depression, concerns over genital size, interpersonal distress, premature ejaculation, low libido, and subjective reports of penile deviation. Adjusted to the World Standard Population, the prevalence rate for ED was 47%. Phosphodiesterase (PDE) inhibitors gave a poor response among those with low libido and interpersonal distress, emphasizing the need for proper diagnosis and psychological counseling parallel to medical treatment. Furthermore, PDE inhibitors were stigmatized with unrealistic concerns that decreased their utility to a great extent.

CONCLUSION: In the study population of Arab-speaking Internet users, prevalence of erectile dysfunction and effect of risk factors have proven similar to reports from different parts of the world, though not unanimously. Premature ejaculation, low desire, concerns over penile size, and penile curvature are factors to be considered in the evaluation of ED patients. PDE inhibitors are stigmatized with false beliefs that should be addressed through mass media and counseling if this population is to take full benefit from this therapeutic option.

2010
Ghanem, H., O. Shaeer, and A. El-Segini, "Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial.", Fertility and sterility, vol. 93, issue 7, pp. 2232-5, 2010 May 1. Abstract

OBJECTIVE: To assess the effect of treatment with a combination of clomiphene citrate as an antiestrogen and vitamin E as an antioxidant on the incidence of pregnancy and sperm variables in men with idiopathic oligozoospermia and infertility.

DESIGN: Prospective, randomized, placebo-controlled trial.

SETTING: The outpatient andrology clinic at a university hospital.

PATIENT(S): Sixty infertile men with idiopathic oligoasthenozoospermia.

INTERVENTION(S): Patients were randomly assigned to two treatment groups: a group receiving the combination of clomiphene citrate (25 mg/day) and vitamin E (400 mg/day; n = 30) against a placebo group (n = 30). Treatment was maintained for 6 months.

MAIN OUTCOME MEASURE(S): Pregnancy incidence and variations in semen parameters.

RESULT(S): A significantly higher pregnancy rate was found among the combination treatment group in comparison to the control group. The odds ratio was 3.76 and the 95% confidence interval was 1.03-13.64, with a 36.7% pregnancy rate (11/30) in the combination treatment group compared with 13.3% pregnancy rate (4/30) in the control group. The trial showed a significantly higher increase in sperm count and progressive sperm motility with nonsignificant changes in total sperm motility, percentage of abnormal forms and semen volume in the combination treatment group as compared to the control group.

CONCLUSION(S): The combination of clomiphene citrate as an antiestrogen and vitamin E as an antioxidant can significantly increase the pregnancy rate and improve sperm count and progressive sperm motility in cases of idiopathic oligoasthenozoospermia.

El Noamani, S., A. M. Thabet, A. A. Enab, O. Shaeer, and A. El-Sadat, "High grade gynecomastia: surgical correction and potential impact on erectile function.", The journal of sexual medicine, vol. 7, issue 6, pp. 2273-9, 2010 Jun. Abstract

INTRODUCTION: Gynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars.

AIM: The purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery.

METHODS: Fifteen male patients with gynecomastia underwent breast reduction using the "no vertical scar reduction mammaplasty." Erectile function was evaluated before and after surgery.

MAIN OUTCOME MEASURES: Surgical outcome and erectile function.

RESULTS: All patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative International Index of Erectile Function (IIEF) score less than 20 denoting erectile dysfunction. All but one (n = 10) showed improvement in their IIEF score following surgery. The difference between pre-operative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant.

CONCLUSIONS: The "no vertical scar reduction mammaplasty" is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function, that can be improved by adequate surgical correction.

Shaeer, O., "Supersizing the penis following penile prosthesis implantation.", The journal of sexual medicine, vol. 7, issue 7, pp. 2608-16, 2010 Jul. Abstract

INTRODUCTION: Following implantation of a penile prosthesis, some couples are dissatisfied with penile length, girth, shaft, or glans engorgement. This may be delusional because of the procedure per se or preexisting risk factors such as neglected priapism, Peyronie's disease, radical prostatectomy, or overhanging suprapubic fat.

AIM: In this work, we try to enhance penile size in patients dissatisfied with its dimensions following implantation of a penile prosthesis, using various augmentation techniques.

METHODS: Eighteen patients who have had penile prostheses implanted were enrolled in this study based on dissatisfaction with penile size. The complaint was relieved by counseling and administration of PDE5 inhibitors in seven patients. Two patients had elongation, girth augmentation, and glans injection; six had elongation and girth augmentation; and two had elongation and glans injection.

MAIN OUTCOME MEASURES: Penile size, satisfaction, and sexual function.

RESULTS: Average preoperative length and girth were 7.87 cm and 11.62 cm, respectively. Mean postoperative length and girth were 11.62 cm and 14.07 cm. The gain in length (47.6%) and girth (21%) were statistically significant (P < 0.005). All patients and partners were satisfied with the results following surgery except one who suffered graft loss.

CONCLUSION: Implantation of a penile prosthesis may improve penile rigidity, yet may confound couple's satisfaction with penile size to variable degrees. Sex education may alleviate those concerns. In refractory cases, penile augmentation may enhance phallic size and increase patient/partner satisfaction.

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