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Category: Male Sexual Dysfunction

Nonsurgical Options for Penile Enlargement A Stretched Fact or a Myth?

Posted on by Dr. Ali Thwaini

Male cosmetic and functional enhancement remains to be an important yet seldom spoken about a topic among men. There have been several proposed treatment options for penile enlargement, most of which are surgical ranging from minimally invasive treatment to open surgery.

However, due to the inherent side effects of these procedures and the time needed to be off work other options have emerged recently was promising results. Below we will discuss one of the conservative options.

Penile Extender Device


This is basically an external device that can be simply applied by the person for a certain amount of time preferably on daily basis. The mechanism of action is stretching on the penis Leading to Mechano-transduction; A process whereby the mechanical stimulus of stretching the penis gets converted into a biochemical stimulation resulting in the progress of cellular proliferation and expansion of the extracellular matrix.

Interestingly, there have been several published small series about the utilization of a penile extender with various encouraging results. Some claim that the use of the penile extender for four hours on daily basis could potentially lead to an increase in the normal penile length of up to 2 cm in a flaccid penis to up to 1.8 cm in stretched penile length.

Others have “extended” the use of penile extender into the treatment of Peyronie’s disease with an encouraging up to 40% improvement of the curvature after a few months of its use.
Of course, any treatment could come with inherent side effects. Penile extender use has the potential of bruising, swelling, and pain ranging between 30 and 40% most of which are simple and self-limiting.

References
Mohammadreza Nikoobakht et al. Effect of the penile-extender device in increasing penile size in men with a shortened penis: preliminary results. J Sex Med. 2011Mohammad Reza Nowroozi et al. Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function. J Sex Med. 2015

The Shortest Distance Between two Points in a Straight Line

Posted on by Dr. Ali Thwaini

Peyronie’s disease is a rather common and potentially debilitating condition for sexually Active men.

What is Peyronie’s disease?

It must be quite unnerving in to wake up on a random morning to see one’s erect penis has “taken a turn”.

While the mainly this condition is idiopathic, some are attributed to various other clinical conditions such as Dupuytren’s contracture.

Painful erections with penile deviation to start with, however, with time, the pain settles leaving behind the penile deviation while erect, which sometimes interferes with sexual activity causing dissatisfaction for the patient and the partner

Treatment

There have been several attempts to treat this condition conservatively and most of these conservative treatments were, at best, equal to placebo.

These have ranged from a variety of supplements like vitamin E, Paraamino Benzoic Acid (Potaba) calcium channel blockers, and even local injection of steroids, with no beneficial effects

Surgical interventions on the other hand provide a definite alternative, however, they come with their inherent side effects.

These are generally divided into penile shortening and penile lengthening procedures;

While the former concentrates on shortening the healthy side of the penis to make it as short as this affected side, this inevitably results in losing some of the erect penis’s length, which all men find unsatisfactory..

Penile lengthening procedures, although seemingly appealing, they have the potential side effect of causing erectile dysfunction as it involves cutting the affected segment that’s responsible for the disease, thus causing the potentially venous leak, which will hinder the erectile process

Recently, there has been some treatment which was initially effective. Collagenase clostridium histolyticum (Xiapex) has been tried with initially promising results, however, due to its significantly high price and the potential side effects of corporal rupture, its use has faded, as with other treatments

Other physical treatments such as external shockwave treatment on Penile remodeling have been attempted with modest results

Regenerative medicine has become a viable alternative in a variety of clinical conditions, and Peyronie’s disease is no different.

Several researchers have attempted the injection of platelet-rich plasma cells (PRP) (with or without hyaluronic acid) into the area of the plaque, in addition to exposing the affected area to shockwave treatment and the results are thus far, promising

It takes one or more sessions depending on the severity of the condition and it is carried out as an outpatient procedure with minimal side effects

The immediate results are encouraging, however, we are still waiting for the intermediate long-term results

Watch the space!

References

Young Adults Male Infertility Causes & Treatment

Posted on by Dr. Ali Thwaini

Infertility is a common problem affecting young adults. At least one and six couples would be suffering from this condition. It is the inability to conceive after one year of unprotected intercourse. While traditionally fingers are always pointing towards the female partner, men are equally responsible for inFertility with 50% being caused by the male factor.

Of course, there are other factors causing infertility despite Both partners having normal parameters. When it comes to male factor infertility, there are several causes such as infections, trauma exposure to toxins, or congenital problems. Many of these factors are easily treatable, however, some might require an intervention to facilitate conception (Assisted fertilization). While this started fairly recently in the 80s with limited success, With the advancement of technology and medical sciences, success rates of dramatically increased.

Sperm harvest, though challenging, is becoming more feasible with the improvement in technology. This includes Microscopic testicular sperm extraction, Epididymal sperm aspiration, etc. The application of regenerative medicine in many aspects of healthcare is becoming more popular, however, when treating infertility, this remains to be experimental. Watch the space!

Dr. Ali Thwaini is one of the urologists and provides male infertility treatment in Dubai

Adult Derived Stem Cells with Low-Intensity Shock Wave for the Treatment of Male Erectile Dysfunction

Posted on by admin

Treatment of Male Erectile Dysfunction

Regenerative medicine is a relatively young field in the treatment of various conditions. Several novel applications of various types of stem cells have been tried and applied in various aspects of urology. Some published articles provide promising early results.
 
There are two main sources of stem cells. These are embryonic stem cells (ESCs) and adult-derived stem cells (ADSC). The latter has many sources including bone marrow stem cells (BMSCs), skeletal-muscle-derived stem cells (SkMSCs), adipose-tissue-derived stem cells (ADSCs), and arguably, amniotic-fluid-derived stem cells (AFSCs).

Stem cell use in urology:

 
BMSCs, SkMSCs, and AFSCs have been used for bladder augmentation and detrusor regeneration in animals. SkMSCs are the only stem cells to have been successfully tested in humans, for the treatment of stress urinary incontinence. ESCs, BMSCs and SkMSCs have been shown to improve erectile function in animal models. Both ESCs and BMSCs can be differentiated into sperm and, remarkably, the ESC-derived sperms have generated offspring in mice.

Adipose-derived stem cells:


ADSC research is a relatively young field, and these cells are largely unstudied in urology. However, as a result of their high differentiation potential and ease of isolation, ADSCs represent an exciting resource for tissue engineering and regenerative medicine within and beyond urology.

ADSC’s need a target tissue to reach and excerpt their regenerative action. Signals are needed from the affected tissue to attract them.

Low-Intensity Shock Wave Therapy (Li-ESWT)

This relatively new modality of treatment is gaining acceptance with encouraging intermediate-term results, as proven with their approval as part of the urology guidelines.

Shock waves appear to induce micro trauma to the tether tissue hence, stimulate vascular flow and erectile function and one possible mechanism of action are through an endogenous stem cell-mediated regenerative effect. This micro trauma not only stimulates the local regenerative process, but the resultant signals act as a lighthouse for the ADSC’s to reach and synergistically enhance the local regenerative and repair process in the penile corpora.

Evidence:

Elliot Lander and Mark Berman reported a case series whereby 52 patients with Erectile Dysfunction received a concurrent combination of Li-ESWTand intracavernosal injection of autologous SVF (rich in MSCs and HSCs) from human lipoaspirate.

Initially SVF was harvested via liposuction and sent for preparation. Patients received Li-ESWT while awaiting the SVF preparation process. Then a tourniquet was applied to the base of the penis and 10 cc of SVF was injected into one side of the corpora cavernosa. The tourniquet was removed after 20 min.

Overall, 37 out of 52 patients (71%) reported an improvement in erectile function after combined SVF and Li-ESWT. None of the other fifteen patients reported worsening of their erectile function after treatment.

Future studies are needed in the form of placebo randomized trials to better establish the effects of stem cells combined with shock waves on Erectile Dysfunction.

Appearance and Performance-enhancing Drugs(APED)

Posted on by admin


So you have been working hard in the gym trying to improve your appearance and performance. Things aren’t moving with the aspired speed. There are other ways to achieve your goal at a much shorter time and minimal side effects, correct?

Wrong! Cutting corners always comes at a price. In addition to the bumpy ride and money spent on APED, you will get some results in improving your “appearance” but at the expense on your performance; both physically and mentally.

Normally cutting corners might get you back in track albeit it at a price. When it comes to using/absolute abusing APEDs, the price is higher, and recovery is significantly longer..

What are APEDs?

  • Anabolic-androgenic steroids. These are synthetic substances similar to the male sex hormone testosterone. They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects) in both males and females
  • Non-steroidal anabolics: include insulin, insulin-like growth hormone (IGF), and human growth hormone (HGH)—substances that are produced by the human body and are prescribed for legitimate medical uses but also sometimes misused for performance enhancement.

There are several misused APEDs, these include:

Oral Steroids
 • Anadrol (oxymetholone)
• Anavar (oxandrolone)
• Dianabol (methandienone )
• Winstrol (stanozolol)
• Restandol (testosterone undecanoate)
Injectable Steroids
 • Deca-Durabolin (nandrolone decanoate)
• Durabolin (nandrolone phenpropionate)
• Depo-Testosterone (testosterone cypionate)
• Agovirin (testosterone propionate)
• Retandrol (testosterone phenylpropionate)
• Equipoise (boldenone undecylenate)

Other Mia-used medications
 Many who practice using APED’s would be keen to try other medications that accentuate the function in terms of enhancing their body image. Some are thermogenics. These are compounds used to decrease body fat or to promote leanness versus muscle mass in endurance athletes.

Examples:

  • Xanthines: compounds that increase attention and wakefulness and suppress appetite. Examples are caffeine, the asthma drug theophylline, and theobromine—a substance found in chocolate, coffee, and tea.
  • Sympathomimetics: drugs that are similar in structure and action to epinephrine and norepinephrine—natural chemicals in the body that increase heart rate, constrict blood vessels, and raise blood pressure. An example is ephedrine, which is derived from the ephedra plant. Ephedrine/ephedra used to be included in dietary supplements that promoted weight loss, increased energy, and enhanced athletic performance. In 2004, the FDA banned the U.S. sale of dietary supplements containing ephedrine/ephedra due to various possible health risks including cardiovascular and nervous system effects.
  • Thyroid hormones: substances that regulate metabolism by altering the function of the thyroid. Cytomel is an example.

Cycling, stacking, pyramiding, and plateauing:

There are several traditionally used methods to inappropriately use these drugs; cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period (so called “clearance”), and starting again.

Stacking means taking two or more different anabolic steroids, mixing oral and/or injectable types, and sometimes even taking compounds that are designed for veterinary use.

Pyramiding is taking APEDs for 6 to 12 weeks, tapering gradually rather than starting and finishing a cycle abruptly. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Steroid users believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows the body’s hormonal system time to recuperate.

Plateauing is another medically unjustified hormonal manipulation whereby steroids are staggered, overlapped, or substituted with another type of steroid to avoid developing tolerance.

Side effects:

The use of anabolic steroids is associated with a wide spectrum of side effects, some of which are mild and others are severe or even life-threatening. Some are temporary and others are semi-permanent or permanent.

One review found 19 deaths in published case reports related to anabolic steroid use between 1990 and 2012.

APEDs effects on body:

Cardiovascular System

Inappropriate use of anabolic steroids could affect the cardiovascular system by raising the blood pressure and interfering with the cardiac function leading to heart failure and cardiac events, in addition to the development of the deranged lipid profile and increasing liability to Venus thrombosis and embolism.

Hormonal System

Abnormal use of steroids leads to disturbance in the hormonal function including testicular atrophy decreased quality and quantity of sperm production degrees libido especially after withdrawal symptoms in addition to sexual dysfunction.

Females with anabolic steroids miss-use will potentially have an adverse effect of these APEDs on the hair leading to frontal boldness, in addition to deepening of the voice. With continued administration of steroids, some of these effects become irreversible. It is commonly believed that anabolic steroids will produce irreversible enlargement of the clitoris in females.

Liver damage

Chronic use of APEDs is associated with impaired liver function, hepatic cysts, and in rare cases, malignancy

Musculoskeletal System

Unjustified use of anabolic steroids in adolescence might potentially lead to premature closure of the growth plates for the bones leading to short stature. In addition, excessive use of anabolic steroids needs to change in stiffening, which might lead to a tendon injury.

Skin

Acne, unsightly and uncomfortably oil skin. Yellowish discoloration in advanced cases of liver damage

Behavioral changes

An experienced andrologist would be able to spot APED users from a distance. There’s a clear agitation and aggression in extreme cases. In addition, anabolic steroid abusers would suffer from anxiety lack of sleep and depression.

Although testosterone replacement in cases of deficiency has a proven fact on improving the cognitive function in the construction ability, younger people using anabolic steroids excessively might suffer from cognitive dysfunction Maile lots of attention span and concentration ability.

How to treat an existing case of a PED miss-use:

This is naturally and multidisciplinary team Approach. This includes the following:

  • Endocrine treatment to restore the answer genic function for those with withdrawal symptoms
  • Antidepressants for those who do not respond to Endocrine replacement therapy
  • Psychological assessment and support for those who are suffering from body dysmorphia.

In summary:

Are the use of appearance and performance-enhancing drugs as an increasing phenomenon at an alarming rate with serious potentially permanent consequences affecting young Adolescence and adults. There needs to be white education about their potential side effects and in case of medical needs for these medications this should take place under strict supervision. Those who are interested in enhancing their appearance and performance should concentrate on the physiological increase by Healthy diet and exercise.

Otherwise, cutting corners by unjustified usage of these medications would possibly give short term results and definitely give long-term consequences

Reference: drugabuse



Extra Caporal Shockwave Treatment plus Regenerative Medicine and Treating a Male Sexual Dysfunction: An update

Posted on by Dr. Ali Thwaini

Male sexual dysfunction is an increasing modern life condition with more than 40% of men being affected as age of 40. This is further complicated by the increasing prevalence of metabolic syndrome and the sedentary lifestyle. This has led to ever increasing incidence of atherosclerosis hyperlipidemia and type two diabetes.

Natural Cures for Erectile Dysfunction

In addition to the importance of the emphasis on improving the lifestyle measures and treating a male sexual dysfunction(Mainly in the form of exercise stopping smoking minimizing the alcohol intake and adopting healthy diet), Other medications seem to help Though on a temporary basis.

Recently there has been increasing interest and more permanent and as close to natural as possible solutions for male sexual dysfunction. Below are some of them:

Low-Intensity Extracorporeal Shock Wave Therapy

LiESWT:Shockwave therapy was introduced since the early 80s with the first experience being targeted towards kidney stones. However, recently, studies have shown that microtrauma and used by shockwaves would lead to an acute inflammatory reaction of the effect of tissues with the resultant stimulation of the healing process towards normality.

This would theoretically stimulate the growth and development of small blood vessels with the resultant increase blood flow to the affected area. This has been adopted and treatment of cardiovascular diseases and other several musculoskeletal conditions.

Urology, being at the forefront of other specialties, has adopted this method and treating various mail conditions including Peyronie’s disease and Erectile dysfunction.

Although shockwave treatment as monotherapy has now been adopted at the Urology guidelines its results are marginally encouraging With an estimated success rate of around 70%. The treatment is fairly simple considering 2 to 3 weekly attendances is at the clinic with a 15-minute session per visit for up to six weeks and the results are expected between three and six months

Platelet-rich plasma cells

Another recently adopted treatment for a variety of medical conditions mainly cosmetic with the principle of using the patients’ own fluids after being purified, keeping the platelets and other essential growth factors and nutrients and possibly Stem Cells, to help regenerating and repairing the damage tissues.

While this method is widely adopted in various clinical conditions, its effectiveness in treating erectile dysfunction is yet to be determined

Whilst there are several animal studies a demonstrating the improvements of the erectile tissue following PRP treatment there are no human trials supporting the above.

Stem cell therapy:

Stem cells are “toti-potential” and their nature with the ability to grow and regenerate and eventually specialize into functional sells according to the organ they are being introduced to

There are few but reliable human studies mainly in treating men with erectile dysfunction following radical prostatectomy with the stem cell therapy and the results are very encouraging with more than 80% success in terms of improving erections and penetration until orgasm. However, the number of participants in these trials as very limited.

Stem Cells and LiESWT combined:

The aim of injecting the Stem Cells is to direct them into the targeted area with the aim of repairing and regenerating cells and resultant improvement of the function of that organ.

Stem Cells, however, need guidance to go to the affected area. There are several animal studies demonstrating and using microtrauma to the target in the organs followed by injection of Stem Cells with the resultant of higher concentration of those cells to go to the affected tissue.

Hence, logically, by combining low intensity ESWT and stem cell therapy at the same time might improve the delivery of the stem cells and the two methods would yield more encouraging results in treating erectile dysfunction.

Ongoing studies regarding the above are being carried out and the results are anxiously awaited

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