Biomedical subjects

Samir Elhanbly

Publications and source records attributed to Samir Elhanbly.

4 recordsLinked to original sources

PubMed2005

Effect of cryptorchidism and retractile testes on male factor infertility: a multicenter, retrospective, chart review.

This multicenter retrospective chart review study performed on 162 cryptorchid patients and on 34 subjects with retractile testes suggests that cryptorchidism and retractile testes can alter spermatogenesis, with more serious damage observed in bilateral cryptorchidism. This spermatogenetic impairment is probably related to the lack of an appropriate or timely surgical correction.

Adult↗

PubMed2002

What nonresponse to intracavernous injection really indicates: a determination by quantitative analysis.

PURPOSE: In addition to its usefulness as a therapeutic modality, intracavernous injection may also be done in a diagnostic capacity. While a good response to an intracavernous injection test rules out venous leakage, a failed erectile response to the test in the office setting may not be completely representative of the patient erectile state. We determined by quantitative analysis the likely significance of failure to respond to intracavernous injection testing. MATERIALS AND METHODS: Patients evaluated with the standard erectile dysfunction assessment at our andrology clinic between 1996 and 1999 were included in analysis. All 122 patients who did not meet study exclusion criteria underwent a test dose of intracavernous injection with papaverine, phentolamine and prostaglandin E1. Regardless of the response or lack of response to the test the men then underwent nocturnal penile tumescence testing, penile blood flow study and re-dose pharmacocavernosography. Results of these adjunctive tests were compared to the outcome of a papaverine, phentolamine and prostaglandin E1 intracavernous injection test by quantitative analysis. RESULTS: A total of 87 patients failed to respond to the test dose. Average age of the nonresponders versus responders was 46.8 versus 33.8 years. The duration of erectile dysfunction in nonresponders versus responders was 31.0 versus 13.7 months. Poor intracavernous injection responders required an average of 1.9-fold greater induction flow and 6-fold greater maintenance flow than good responders. Receiver operator characteristics (ROC) curve analysis revealed that the best predictors of the intracavernous injection test response were erectile dysfunction duration (ROC 0.99), patient age (ROC 0.87), maintenance flow (ROC 0.86), pressure loss (ROC 0.83) and resistive index (ROC 0.82). The ROC area for peak systolic velocity was 0.69. CONCLUSIONS: Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.

Adrenergic alpha-Antagonists↗

PubMed2002

The role of testicular biopsy in the modern management of male infertility.

PURPOSE: We evaluate the traditional role of isolated testicular biopsy as a diagnostic tool, as opposed to the value as a therapeutic procedure for azoospermic men. MATERIALS AND METHODS: The medical records of azoospermic patients who were evaluated, and treated between 1995 and 2000 were retrospectively analyzed for history, physical examination findings, endocrine profiles, testicular histology and sperm retrieval rates. Based on these parameters, cases were placed into diagnostic categories that included obstructive or nonobstructive azoospermia. Diagnostic parameters used to distinguish obstructive from nonobstructive azoospermia were subjected to statistical analysis with the t-test, analysis of variance and receiver operating characteristics curve. RESULTS: A total of 153 azoospermic men were included in our analysis. Of men with obstructive azoospermia 96% had follicle-stimulating hormone (FSH) 7.6 mIU/ml. or less, or testicular long axis greater than 4.6 cm. Conversely, 89% of men with nonobstructive azoospermia had FSH greater than 7.6 mIU/ml., or testicular long axis 4.6 cm. or less. Receiver operating characteristics analysis revealed that FSH, testicular long axis, and luteinizing hormone were the best individual diagnostic predictors, with areas 0.87, 0.83 and 0.79, respectively. CONCLUSIONS: In the vast majority of patients obstructive azoospermia may be distinguished clinically from nonobstructive azoospermia with a thorough analysis of diagnostic parameters. Based on this result, we believe that the isolated diagnostic testicular biopsy is rarely if ever indicated. Men with FSH 7.6 mIU/ml. or greater, or testicular long axis 4.6 cm. or less may be considered to have nonobstructive azoospermia and counseled accordingly. These men are best treated with therapeutic testicular biopsy and sperm extraction, with processing and cryopreservation for usage in in vitro fertilization and intracytoplasmic sperm injection if they accept advanced reproductive treatment. Diagnostic biopsy is of no other value in this group. Men with FSH 7.6 mIU/ml. or less, or testicular long axis greater than 4.6 cm. may elect to undergo reconstructive surgery with or without testicular biopsy and sperm extraction, or testicular biopsy and sperm extraction alone depending on their reproductive goals.

Analysis of Variance↗

PubMedDate not supplied

Erectile dysfunction in smokers: a penile dynamic and vascular study.

In this study, we aimed to determine the hemodynamic mechanisms through which cigarette smoking, as an independent risk factor, induces erectile dysfunction (ED). We performed a standard ED evaluation that included history; a physical exam; and serum glucose, testosterone, and prolactin levels. We then excluded ED patients with abnormal androgen profiles and patients with ED risk factors other than smoking. A total of 109 ED patients entered the study, including 71 current smokers and 38 nonsmokers. All patients then underwent extensive evaluation, including nocturnal penile tumescence and rigidity (NPTR) monitoring with Rigiscan, followed by pharmacopenile duplex ultrasonography (PPDU) and redosing pharmacocavernosometry (RPC). Results of the above tests were compared in the smoker and nonsmoker groups. We also performed receiver operating characteristic (ROC) curve analysis to determine which diagnostic parameter is most affected by cigarette smoking. The 4 most significant variates served as input features for a logistic regression model, designed to predict smoking. The average age for smokers and nonsmokers was 44.3 and 51.2 years, respectively (P = .02). Eighty-six percent of smokers had abnormal NPTR testing compared with 55% of nonsmokers (P = .02). The average peak systolic velocity (PSV) was 26.8 and 31.2 cm/s for smokers and nonsmokers, respectively, and this difference was not found to be statistically significant (P = .19) in this study. On performing RPC, an abnormal maintenance flow (MF) of >5 mL/min was detected in 89% of smokers and in 47% of nonsmokers, and the difference was significant (P < .01). With the use of smoking as the outcome, the ROC area of different diagnostic parameters was as follows: 0.79 for penile base rigidity, 0.58 for PSV, and 0.77 for MF. A logistic regression model that used the 4 most significant variates as input features yielded a ROC of 0.857. The results of NPTR testing in our smoker and nonsmoker groups indicated that ED in smokers is mainly of organic etiology. On the basis of the PPDU findings and the higher incidence of abnormal MF in the smoker group and its relatively high ROC value, we concluded that dysfunction of penile veno-occlusive mechanisms plays a substantial role in the development of ED in smokers.

Adult↗