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Shaeer, O. K. Z., and K. Z. Shaeer, "Pelviscrotal vasovasostomy: refining and troubleshooting.", The Journal of urology, vol. 174, issue 5, pp. 1935-7, 2005 Nov. Abstract

PURPOSE: Obstruction of the vas deferens in the inguinal canal may occur as a sequel of inguinal surgery. The condition is occurs in 26.7% of cases following childhood herniotomy. Open surgery in the inguinal region for anastomosing the remnants of the vas is difficult and associated with high morbidity. We have previously reported an alternative based on anastomosing the pelvic vas deferens (harvested laparoscopically) to the scrotal vas deferens and bypassing the inguinal vas. This technique, termed Shaeer pelviscrotal vasovasostomy, is easier to perform with much less morbidity. In this study we present the results of performing the procedure bilaterally at the same session as well as technique troubleshooting.

MATERIALS AND METHODS: A total of 25 patients with azoospermia due to inguinal obstruction of the vas deferens underwent unilateral (15) or bilateral (10) surgery. Patients were followed for 1 year.

RESULTS: Of the 25 patients 17 (68%) had a sperm concentration of between 11.88 and 17 million per ml. Some patients who remained azoospermic underwent reoperation and the obstacles to a successful anastomosis were analyzed and resolved.

CONCLUSIONS: Shaeer vasovasostomy is a practical approach to inguinal obstruction of the vas deferens. It enables a reliable anastomosis, simultaneous bilateral repair and lower morbidity in terms of wound healing and hernia as well as a shorter convalescence.

Shaeer, O., and A. El-Sebaie, "Construction of neoglans penis: a new sculpturing technique from rectus abdominis myofascial flap.", The journal of sexual medicine, vol. 2, issue 2, pp. 259-65, 2005 Mar. Abstract

INTRODUCTION: Construction of a neoglans penis may be required following glans amputation at circumcision, strangulation by a hair coil, or self-mutilation, among other indications. It may also be combined with phalloplasty to imitate the natural appearance and to support a penile prosthesis.

AIM: This is a report on a novel technique of neoglans construction for a patient with an amputated glans penis as a result of circumcision injury.

METHODS: A rectus abdominis myofascial flap was used. The flap was designed to be a 12 x 4 cm segment of the infraumbilical portion of the muscle, based on the inferior epigastric vessels. The flap was harvested through a paramedian incision. The penis was partially degloved through a circumferential incision 1 cm below its summit. The distal penile skin was utilized to elongate the urethra, so that the urethral meatus would be at the tip of the neoglans. The flap was reflected and tunneled underneath the mons veneris and alongside the penis, to emerge distal to the summit of the penis. The flap was fashioned into the shape of a glans and secured in place around the neourethra. The impression of a corona was achieved by tucking the proximal edge of the flap to its undersurface.

RESULT: Six months following surgery, the patient had a neoglans penis, a corona, and a urethral meatus at the very tip. The neoglans had similar consistency, color, and shape to the normal glans.

CONCLUSION: Construction of a neoglans penis is possible using the described sculpturing techniques, with satisfactory cosmetic results.

Shaeer, O. K. Z., and K. Z. Shaeer, "Laparoscopy-assisted pelvi-scrotal vasovasostomy.", Andrologia, vol. 36, issue 5, pp. 311-4, 2004 Oct. Abstract

Iatrogenic obstruction of the vas deferens within the inguinal canal can be managed by direct on-site vasovasostomy. However, in cases with large defect of the vas, the anastomosis may be under tension. Dissecting through the site of a previous hernia repair is tedious, and may lead to recurrence of the hernia. The present work reports an, first of a kind, alternative technique that avoids the latter drawbacks. Fifteen cases were operated upon. Under laparoscopic vision, the pelvic vas was dissected and the lateral-most end was clipped, cut and extruded from the abdomen through a port in the external inguinal ring. End-to-end vasovasostomy and microsurgical anastomosis for the vasal vessels were performed, bridging the retrieved stump of the pelvic vas with the scrotal vas. There were positive results in the form of sperm count ranging from 1.5 to 15 million ml(-1), an average of 7.25 (SD 5.44) in nine of 15 cases (60%), within the first 6 months following surgery. "Pelvi-scrotal vasovasostomy" can be offered as a cost-effective and successful alternative or supplement to intracytoplasmic sperm injection, for cases with iatrogenic large defects of the vas deferens within the inguinal canal.