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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.

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.

Shaeer, O., "Shaeer's Corporal Rotation.", The journal of sexual medicine, vol. 7, issue 1 Pt 1, pp. 16-9, 2010 Jan. Abstract
Shaeer, O., K. Shaeer, and A. Shaeer, "Botulinum toxin a (Botox) for relieving penile retraction.", The journal of sexual medicine, vol. 6, issue 10, pp. 2788-94, 2009 Oct. Abstract

INTRODUCTION: The flaccid penis undergoes retraction upon contraction of the dartos muscle. These contractions are most pronounced in the situations of cold, stress, and upon exercising, and can be the source of embarrassment to those who have a hyperactive retraction reflex, especially when exposed to their partners or to others in showers and dressing rooms, despite a normal and satisfactory length in the erect state.

AIM: In this work, we propose an alternative to surgery and penile extenders for alleviating penile retraction, by injection of botulinum toxin into the dartos to induce muscle relaxation. This is the first report of the technique.

METHODS: Ten male patients complaining of a short penis exclusively in the flaccid state, despite normal and satisfactory erect and outstretched lengths, were selected for the study. One hundred units of BOTOX were injected into the dartos muscle.

MAIN OUTCOME MEASURES: Frequency and amplitude of penile retraction, flaccid unstretched length, and patient satisfaction.

RESULTS: Seven out of 10 cases (70%) subjectively reported a decrease in the frequency and amplitude of penile retraction, as well as improvement in flaccid length. Clinical measurements were less pronounced but still showed an improvement that was mainly in terms of less retraction rather than more length. No side effects were reported. Improvement faded completely by the 6th month.

CONCLUSION: This preliminary report of botulinum toxin A (Botox) injection into the dartos muscle shows that Botox may have a potential effect in temporarily decreasing penile retractions in terms of frequency and amplitude.

Shaeer, O., and K. Shaeer, "Revealing the buried penis in adults.", The journal of sexual medicine, vol. 6, issue 3, pp. 876-85, 2009 Mar. Abstract

INTRODUCTION: Several surgical solutions have been proposed for resolving penile concealment with successful outcomes. Those include liposuction, adhesiolysis, and suprapubic lipectomy through the abdominal crease. Nevertheless, some limitations exist and compromise the results of surgical correction.

AIM: This work presents our technique for revealing the hidden penis, addressing the limitations of existing methods for surgical correction.

METHODS: Sixty-four adult males with buried penis were operated upon. The penis was revealed by the combination of adhesiolysis, suprapubic and lateral lipectomy, anchoring the penoscrotal and penopubic junctions, and skin coverage by a local flap.

MAIN OUTCOME MEASURES: Penile length in the flaccid and erect states.

RESULTS: Average postoperative length in the flaccid state was approximately 7 cm +/- 1.3 (a 293% increase) and in the erect state was 18.4 cm +/- 2.9 (185.7% increase), compared with preoperative length of 1.8 cm +/- 0.4 in the flaccid state and 6.4 cm +/- 1.6 in the erect state. Minor complications occurred. There was no deterioration in sexual function.

CONCLUSION: Revealing the concealed penis is a complicated procedure. The outcome may be improved by implementing a radical approach to tissue excision, providing adequate skin coverage, and anchoring the penile shaft, skin, and subcutaneous tissues in the revealed state to prevent relapse.

Shaeer, O., and K. Shaeer, "Delayed complications of gel injection for penile girth augmentation.", The journal of sexual medicine, vol. 6, issue 7, pp. 2072-8, 2009 Jul. Abstract

INTRODUCTION: Penile girth augmentation is a domain of extensive controversy and debate. A variety of methods is available for the choice of the surgeon including dermal-fat grafts and flaps. The need for a simple procedure with minimal donor site has lead to proposing injection therapy for penile augmentation, whether by fat or synthetic materials.

AIM: This work reports on a male patient suffering a deforming subcutaneous mass in the penis following penile girth augmentation by injection therapy using synthetic material, and describes its management, and pathologic analysis of the extracted tissue.

METHODS: The mass was excised through a circumferential subcoronal incision while maintaining skin vascularity and integrity of the corpora. The excised tissue was microscopically examined.

MAIN OUTCOME MEASURES: Cosmetic and functional results of surgical correction.

RESULTS: Cosmetic and functional outcome were acceptable. Pathology examination revealed features of foreign body granuloma.

CONCLUSION: Injection of fillers for girth augmentation of the penile shaft may result in delayed complications including migration, granulomatous reaction, and resorption that may occur beyond the follow-up span of the currently available study that recommends its use.

Shaeer, O., "Implantation of penile prosthesis in cases of corporeal fibrosis: modified Shaeer's excavation technique.", The journal of sexual medicine, vol. 5, issue 10, pp. 2470-6, 2008 Oct. Abstract

INTRODUCTION: Implantation of penile prosthesis in case of corporeal fibrosis poses a greater risk of complications because of the blinded aggression involved. Penoscopic excavation and ultrasonography-guided excavation can decrease these complications but still have limitations.

AIM: This work described the combination of penoscopy-guided and ultrasound-guided excavation in a trial to eliminate the limitations inherent to both.

METHODS: Twelve patients with penile fibrosis were operated upon. A guide wire was inserted under ultrasound monitoring, along which penoscopic corporotomy and resection was performed. Ultrasound was also used to monitor penoscopic excavation toward the tip of the corpus cavernosum and crus.

MAIN OUTCOME MEASURES: Ease of the procedure, safety, extent of dilatation, and girth of prosthesis implanted.

RESULTS: The procedure was relatively easy. Ten cases were dilated up to size 13.5 Hegar, and two up to size 14. Size 13 prosthesis was implanted in all cases.

CONCLUSIONS: The relative safety of the procedure, the low incidence of complications, the possibility of restoring length and girth to an extent, and the resultant generous dilatation of the corpora for accommodating a sizable unhindered inflatable penile prosthesis all make ultrasound-guided penoscopic corporotomy and resection a valid option for prosthesis implantation in cases of penile fibrosis.

Shaeer, O., "Shaeer's corporal rotation for length-preserving correction of penile curvature: modifications and 3-year experience.", The journal of sexual medicine, vol. 5, issue 11, pp. 2716-24, 2008 Nov. Abstract

INTRODUCTION: Correction of penile curvature by corporal rotation enabled the correction of 90 degrees ventral curvature with neither shortening nor erectile dysfunction. However, some limitations were described, and only one case was reported upon.

AIM: This work described a 3-year experience with corporeal rotation, the modifications addressing and eliminating its drawbacks and limitations, as well as the long-term follow-up of 22 patients.

METHODS: Modified corporeal rotation was performed in 22 patients with various degrees of curvature. Degree of deviation, erect penile length, symmetry, and erectile function were evaluated and compared pre- and postoperatively.

MAIN OUTCOME MEASURES: Correction of curvature, resultant sexual function, penile length, and girth.

RESULTS: Full correction of curvature was achieved in 20 out of 22 patients, with no shortening, asymmetry, or erectile dysfunction. Residual curvature in two patients was no more than 10 degrees.

CONCLUSIONS: Corporal rotation can restore straightness to the penis with no loss in phallic length, asymmetry, or erectile dysfunction. While a variety of surgical techniques are feasible for the correction of milder degrees of curvature, we believe that severe degrees should be spared the shortening and corrected by corporeal rotation.

Shaeer, O., "Management of distal extrusion of penile prosthesis: partial disassembly and tip reinforcement by double breasting or grafting.", The journal of sexual medicine, vol. 5, issue 5, pp. 1257-62, 2008 May. Abstract

INTRODUCTION: Distal erosion and perforation of penile prosthesis have been reported in association with neurologic impairment, diabetes mellitus, and following irradiation for prostatic cancer. Once perforation occurs, reimplantation carries a higher risk of reperforation unless adequate preventive measures are taken. Aim. This is a description of a procedure whereby the point of perforation was exposed and repaired to restore distal support.

METHODS: In three patients with distal extrusion of penile prosthesis through the urethra, the glans was mobilized off the tip of the corpus cavernosum and the caverno-urethral fistula was disconnected from the corpus cavernosum. The fistula was sealed by primary sutures. The perforation on the corpus cavernosum side was sealed by double breasting in two cases and by grafting in one case. Prosthesis was reimplanted.

MAIN OUTCOME MEASURES: Complications, recurrence of erosion, and postoperative coital pain.

RESULTS: No complications, recurrence, or persistent pain occurred in any of the three cases.

CONCLUSION: The management of the distal extrusion of penile prosthesis by partial disassembly, double breasting, or grafting may provide reliable distal support and thereby avoid reperforation and repeated extrusion.

Shaeer, O., "Torsion of the penis in adults: prevalence and surgical correction.", The journal of sexual medicine, vol. 5, issue 3, pp. 735-9, 2008 Mar. Abstract

INTRODUCTION: Torsion of the penis is a condition where the penis rotates around its longitudinal axis, whether congenital or acquired. Extreme degrees may provoke a cosmetic complaint.

AIM: We describe surgical correction of congenital torsion of the penis in adults, and its prevalence among a special patient group.

MAIN OUTCOME MEASURES: Success and ease of surgical repair.

METHODS: Sixteen cases with congenital torsion were operated upon, by counter-rotation, using a dartos flap in eight cases, and skin realignment in the other eight. The prevalence of congenital torsion was examined in 12,307 patients attending two andrology clinics.

RESULTS: Full correction was achieved in all cases. Skin realignment was easier and faster than dartos flap, and was equally effective. Congenital torsion was present in 11.993% of the epidemiologic study group, mild in 80%, moderate in 15%, and severe in 5%. Only 2.2% was bothered by the condition.

CONCLUSION: Torsion of the penis is not uncommon but rarely provokes a complaint. Surgical repair by degloving and skin realignment is effective and easy. Dartos flap technique may be utilized if the former is inadequate.

Ateyah, A., T. Mostafa, T. A. Nasser, O. Shaeer, A. A. Hadi, and M. A. Al-Gabbar, "Penile fracture: surgical repair and late effects on erectile function.", The journal of sexual medicine, vol. 5, issue 6, pp. 1496-502, 2008 Jun. Abstract

INTRODUCTION: Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis.

AIM: To assess the etiology, treatment maneuvers, and late effects of penile fractures treated by surgical repair.

METHODS: Thirty-three patients diagnosed provisionally as having fractured penises. Thirty patients were managed by immediate surgical repair and three by delayed repair.

MAIN OUTCOME MEASURES: International Index of Erectile Function-5 for married cases and Single-question Self-report of Erectile Dysfunction questionnaires and recording complications after 2, 3, and 6 months.

RESULTS: The most common cause of fracture penis is self-inflicted acute bending (54.5%). The tear was visualized by ultrasound in 20/30 patients (66.7%) mostly on the right proximal third of the penis. All tears were unilateral with mean length 2.0 +/- 0.9 cm (range 0.5-4 cm). All patients who completed their follow-up after 6 months (N = 24) were able to achieve an adequate erection except two married cases who felt mild erectile dysfunction. Penile nodules were the most common postoperative complication (41.7%) after 6 months' follow-up. Patients treated with immediate or delayed repair had comparable complications.

CONCLUSIONS: Fracture penis is not uncommon as an emergency that must be repaired either immediately or delayed. Clinical diagnosis is more predictive than ultrasound in diagnosis and determining the site of the tear. Ultrasound may be of value in patients where there is clinical doubt.

Shaeer, O., A. El-Sebaie, A. Sherif, A. El-Sadat, and A. Shaeer, "Glans reconfiguration for management of glanular mutilation.", The journal of sexual medicine, vol. 5, issue 2, pp. 500-3, 2008 Feb. Abstract

INTRODUCTION: The glans penis is prone to mutilation in a handful of conditions, some accidental and others iatrogenic. Deformed functioning remnants of the glans challenge the surgeon's decision. Neither is the glans totally amputated, justifying a neoglansplasty, nor are the remnants cosmetically acceptable, though retaining sensibility and engorgement.

AIM: In this work, we described the "reconfiguration of the glans penis" whereby deformed glanular tissue remnants can be made into a functional and cosmetically acceptable glans.

METHODS: Five patients with separate mutilated lumps of functioning glanular tissue were operated upon. The lumps were mobilized and flattened into sheets and configured to redrape the summit of the penis, minding their vascular and nerve supply.

MAIN OUTCOME MEASURES: Cosmetic and functional outcome.

RESULTS: The outcome was cosmetically acceptable for all patients in comparison to the preoperative state.

CONCLUSION: Glans reconfiguration may possibly confer an acceptable cosmetic outlook to a mutilated glans without compromising valuable functional characteristics.

Shaeer, O., "Restoration of the penis following amputation at circumcision: Shaeer's A-Y plasty.", The journal of sexual medicine, vol. 5, issue 4, pp. 1013-21, 2008 Apr. Abstract

INTRODUCTION: Male circumcision is one of the most commonly performed procedures worldwide. It has an estimated complication rate ranging from 0.1% to 35%. Amputation of the shaft is one of the most devastating complications reported, resulting from entrapment of the phallus between the blades of the clamp or from thermal injury due to the application of unipolar diathermy.

AIM: In this work, I describe the guidelines I adopted in the management of 32 male patients afflicted with amputation of the shaft of the penis upon circumcision.

METHODS: "Shaeer's A-Y plasty" was performed for all patients, whereby the proximal corpora and crura were released from their attachment to the pubis and were advanced forward by insetting a specially configured fat flap into the resultant cavity. Skin grafts were used to cover the released penis.

RESULTS: In all 32 cases, the released penis was within the normal range of penile length, and was cosmetically and functionally acceptable.

CONCLUSIONS: "Shaeer's A-Y plasty" is capable of restoring the native phallus following amputation, with preservation of both gender identity and physiological characteristics of the penis to a large extent.

Shaeer, O., "Penoscopy: optical corporotomy and resection for prosthesis implantation in cases of penile fibrosis, Shaeer's technique.", The journal of sexual medicine, vol. 4, issue 5, pp. 1214-7, 2007 Sep. Abstract
Shaeer, O., "Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation.", The journal of sexual medicine, vol. 4, issue 3, pp. 809-14, 2007 May. Abstract

INTRODUCTION: Implantation of a penile prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra.

AIM: This work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue.

MAIN OUTCOME MEASURES: Clinical outcome data were examined.

METHODS: Surgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, penile prosthesis was implanted.

RESULTS: All implants survived adequately. No complications occurred following implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation.

CONCLUSION: Ultrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue.

Shaeer, O., and A. Shaeer, "Corporoscopic excavation of the fibrosed corpora cavernosa for penile prosethesis implantation: optical corporotomy and trans-corporeal resection, Shaeer's technique.", The journal of sexual medicine, vol. 4, issue 1, pp. 218-25, 2007 Jan. Abstract

INTRODUCTION: Implantation of a penile prosthesis in cases of neglected or resistant ischemic priapism, or delayed re-implantation following prosthesis infection and extraction, is usually a difficult and risky procedure due to fibrosis of the corpora cavernosa. Among the common complications are perforation of the urethra, tunica albuginea, and infection. The complications are usually due to the use of blind force against resistance.

AIM: We propose the techniques of Trans-Corporeal Resection and Optical Corporotomy as adjuvant measures for excavating the fibrosed corpora cavernosa under vision, without the use of force against resistance.

METHODS: Six patients with diffuse fibrosis of the corpora cavernosa were operated on. The instruments and technique are the same as for optical urethrotomy and transurethral resection. Optical Corporotomy was started with, where the corpora are incised from within. After establishment of a satisfactory passage, Trans-Corporeal Resection followed to scrape the fibrous tissue. Implantation of penile prosthesis was completed as usual. The procedure was performed through 1.5 cm incision in the tunica albuginea.

MAIN OUTCOME MEASURES: Length, girth, and straightness in the erect position, as well as the incidence of complications.

RESULTS: Operative time was an average of 90 minutes. No difficulty was encountered during the procedure. No complications were noted through 1 year of follow-up.

CONCLUSION: Optical Corporotomy and Trans-Corporeal Resection allow for force-free, visually monitored excavation of the fibrosed corpora cavernosa, aiming at safer penile prosthesis implantation.

El-Karaksy, A., T. Mostafa, O. K. Shaeer, D. R. Bahgat, and N. Samir, "Seminal mast cells in infertile asthenozoospermic males.", Andrologia, vol. 39, issue 6, pp. 244-7, 2007 Dec. Abstract

This work aimed to assess the possible association between the presence of seminal mast cells and asthenozoospermia. One hundred and seventy-six male subjects were investigated: group (Gr)1 (n=46) normozoospermic fertile controls, Gr2 (n=62) idiopathic asthenozoospermia, Gr3 (n=32) asthenozoospermia with scrotal varicocele and Gr4 (n=36) asthenozoospermia with leucocytospermia. Four smear slides were prepared for each semen sample to be stained with toluidine blue-pyronin to detect mast cells. A significant increase was shown in mast cell-positive samples among varicocele-associated and idiopathic asthenozoospermic patients in comparison with fertile controls. Seminal mast cells were also detected at higher frequency among smokers and in age group over 40 years. It is concluded that mast cells and their products may play a pivotal role in the pathogenesis of asthenozoospermia, possibly proposing a new goal for medical treatment of infertile males to pursue. In addition, this concept may in a way detain smoking as a cause of male infertility considering the clear abundance of mast cells in semen samples of smokers.

Shaeer, O., "Correction of penile curvature by rotation of the corpora cavernosa: a case report.", The journal of sexual medicine, vol. 3, issue 5, pp. 932-7, 2006 Sep. Abstract

AIM: We report on the corporal rotation technique, customized for the management of ventral curvature in patients without hypospadias.

METHODS: A male patient with ventral curvature of 90 degrees was operated on. The neurovascular bundle was mobilized for a short distance at the point of maximum curvature. The corpora cavernosa were approximated to each other in the dorsal midline by suturing pairs of longitudinal parallel incisions. To avoid urethral narrowing, minimal dissection was used to develop the groove on either side of the corpus spongiosum, to release it from its attachment to the rotated corpora cavernosa.

RESULTS: Full correction of the curvature was achieved, without shortening, erectile dysfunction, or micturition problems.

CONCLUSION: Corporal rotation can be applied for the correction of ventral penile curvature in patients with and without hypospadias, without sacrificing penile length.

Shaeer, O. K. Z., and A. El-Sadat, "Urethral substitution using vein graft for hypospadias repair.", Journal of pediatric urology, vol. 2, issue 5, pp. 518-21, 2006 Oct. Abstract

OBJECTIVE: Complex hypospadias surgery requires abundant and stretchable tissues for urethroplasty. Genital skin is ideal for this purpose but is often unavailable in re-do cases. Extragenital tissues have their drawbacks such as the limited length of buccal and bladder mucosa, and contracture of skin grafts. Tubularization and on-lay techniques comprise one or two longitudinal suture lines that are the source of complications. We investigate the possibility of using a saphenous vein graft to construct a long, wide, stretchable and pre-tubularized neourethra that is not compromised by the longitudinal suture line.

PATIENT AND METHOD: A male patient with proximal hypospadias for which surgical correction had failed underwent the operation. The patient had a penoscrotal meatus and was circumcised. A saphenous vein graft was passed through a tunnel created on the ventral aspect of the penis, and was anastomosed to the urethra proximally and the distal opening of the tunnel at the tip of the penis.

RESULTS: After 12 months, the patient had a forward stream, no dilatation of the neourethra, and no penile curvature upon morning erection (as reported by the parents).

CONCLUSION: This initial experience with saphenous vein urethroplasty shows that the technique is feasible, and may provide a reliable and practical alternative to the current techniques.

Shaeer, O., "Methylene blue-guided repair of fractured penis.", The journal of sexual medicine, vol. 3, issue 2, pp. 349-54, 2006 Mar. Abstract

INTRODUCTION: Fracture of the penis is a condition where excessive force applied to the long axis of the penis in the erect state results in rupture of the tunica albuginea of the corpus cavernosum. Surgical management can be confusing and time-consuming due to the concealment of the tear in organized blood and edematous tissue, necessitating extensive dissection in friable traumatized tissues, especially if the tear is a small one, or if there are multiple tears.

AIM: The present work investigates the value of methylene blue in aiding the localization of tunical and urethral tears in such cases.

PATIENTS AND METHODS: Twelve cases with delayed presentation of fracture penis were managed. In six patients, methylene blue was injected into the corpora cavernosa and through the urethral meatus to point out tears. In the other six patients, methylene blue was not used.

MAIN OUTCOME MEASURES: Operative time and complication rate.

RESULTS: Operative time was considerably less in the group that received methylene blue, and the repair was more straightforward. Complications issued only in the group that did not receive methylene blue considering the extensive lengthy dissection.

CONCLUSION: Methylene blue-guided repair for trauma of the penis is an easy, reliable, safe, and fast method for spotting tears in the tunica albuginea of the corpora cavernosa or in the urethra, eliminating the need for unnecessary lengthening.

Shaeer, O., K. Shaeer, and A. El-Sebaie, "Minimizing the losses in penile lengthening: "V-Y half-skin half-fat advancement flap" and "T-closure" combined with severing the suspensory ligament.", The journal of sexual medicine, vol. 3, issue 1, pp. 155-60, 2006 Jan. Abstract

INTRODUCTION: The technique most commonly used for penile lengthening is the release of the suspensory ligament in combination with an inverted V-Y skin plasty. This technique has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection.

AIM: In this work, we describe a new technique that overrides these drawbacks and minimize the loss of gained length.

METHODS: The suspensory ligament was released through a penopubic incision. The caudal flap of the resected ligaments was reflected caudally and sutured to the Buck's fascia. The V flap was incised. The caudal half of the V was deskinned, leaving a cranial skin-covered V flap, and a caudal, rectangular fat flap. The fat flap was pulled into the gap between the base of the penis and the pubis and secured in position by suturing its deep surface and lower edge to the pubis. This maneuver filled up the gap. The V incision was closed as a Y. The penopubic incision was closed as a T shape, to avoid pulling the penis back at skin closure. A stay suture stretched from the glans to the thigh, maintaining the penis in the stretched position. A urinary catheter was inserted.

RESULTS: Six months after surgery, there was no loss in the length gained. The angle of erection (as reported by the patient) was similar to that prior to the procedure. The skin incisions left no hump and a faint scar that was not troublesome to the patient.

CONCLUSION: "V-Y half-skin half-fat advancement flap" and "T-closure" may improve the results of suspensory ligament release for penile lengthening. The reported techniques minimize the losses compromising length gain, whether in-surgery or following it.

Shaeer, O., and K. Shaeer, "Penile girth augmentation using flaps "Shaeer's augmentation phalloplasty": a case report.", The journal of sexual medicine, vol. 3, issue 1, pp. 164-9, 2006 Jan. Abstract

INTRODUCTION: Current girth augmentation techniques rely either on liposuction/injection or on the use of dermal fat grafts. These procedures have serious disadvantages, including regression in gained size, deformities, irregular contour, and asymmetry. Ideally, the augmentation technique should ensure durability and symmetry. This case report describes the first application of a flap (superficial circumflex iliac artery island flap) in penile girth augmentation.

MATERIALS AND METHODS: The superficial circumflex iliac vessels were identified and the groin flap was elevated from lateral to medial, rotated toward the penis, and tunneled into a penopubic incision. It was wrapped around the penis short of the corpus spongiosum and insinuated under the glans.

RESULTS: Six months after surgery, the patient had an erect girth of 19.5 cm and a flaccid girth of 16.5 cm, compared with 11 cm and 7 cm, respectively, before surgery, thus maintaining the intraoperative girth gain. The outer surface felt smooth with no lobulation. The size of the glans was proportionate to the shaft's girth.

CONCLUSION: This case report shows that the application of flaps in penile girth augmentation may provide a reliable alternative to the currently applied techniques. Glans flaring promotes the aesthetic results and is applicable with other techniques of penile girth augmentation.