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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., "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., "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.

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., "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.

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

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

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

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

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

Shaeer, O., I. F. S. AbdelRahman, M. Mansour, and K. Shaeer, "Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation", J Sex Med, vol. 17, issue 7, pp. 1395-1399, 2020.
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., "Shaeer's Corporal Rotation.", The journal of sexual medicine, vol. 7, issue 1 Pt 1, pp. 16-9, 2010 Jan. Abstract
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., I. F. S. AbdelRahman, and K. Shaeer, "Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants.", Sexual medicine, vol. 7, issue 3, pp. 357-360, 2019. Abstract

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

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

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

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

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

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

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., 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., K. Shaeer, and I. F. S. AbdelRahman, "Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion.", The journal of sexual medicine, vol. 16, issue 5, pp. 755-759, 2019. Abstract

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

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

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

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

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

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

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

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

Shaeer, O., 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., "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. 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.

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 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.

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. 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., 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., "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.