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Tag: sexual dysfunction

Stem Cell Therapy in Urethral Stricture Disease; a Concept

Posted on by admin

 
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.
 
Male urethral stricture disease:
 
This is one of the common urological conditions mainly affecting young men, and occasionally older men. The main causes are inflammatory from recurrent urethritis and urethral injury, whether from an accident or iatrogenic.
 
Until recently, the treatment of urethral stricture is mainly surgical, starting from endoscopic dilatation or urethrotomy, both have a high risk of recurrence, starting from 50% with increasing failure of cure in recurrent ones. Several attempts have been made to combat this problem. Many use intermittent dilatation, that though keeps the uretha patent, it induces more inflammatory reactions from repetitive trauma. The other way is major surgery, called urethroplasty, with a higher success rate but comes at a higher price of complications list (such as infection, bleeding, penile curvature, sexual dysfunction, and of course, recurrence of the stricture).
 
The main reason for the failure of urethral dilatations is the inflammatory reaction generated by the procedure, with resulting fibrosis.
 
This where stem cell therapy comes into place. Stem cells provide an alternative way of healing. Once deployed in the area of injury, they differentiate into the local functional cells (in this case the urothelium and possibly, in dense strictures, spongial tissue). This has the potential to prevent the usual inflammatory process that follows trauma, with potentially less scarring.

 Hypothesis:
 
Stem cells, once applied to the area of urethra dilatation/urethrotomy, in the same operative setting, might increase the chance of success of the operation, obviating the need for repetitive endoscopic dilatations and even urethroplasty.

Study proposal and methods:
 
A prospective randomized double blinded study is proposed, aiming at recruiting 40 participants;
 

  • Group I: n=20 who would receive the conventional urethral dilatation/optical urethrotomy. In addition, they would receive ADSC.
  • Group II: n=20 would receive the conventional urethral dilatation/optical urethrotomy.
     
    Procedure (Group I):
     
    Under general anaesthesia (whilst having the urethral dilatation). ADSC will be harvested by liposuction from the abdominal fat using micro-cannula and two tiny abdominal wall incisions. This fat would be then treated for mechanical extraction of the stem cells using purposely made nano blades. The process would take an extra half-an-hour to prepare. The resultant fluid containing stem cells would be then injected via the cystoscope into the area of the urethral dilatation/urethrotomy.

Post-operative care:
 
Both groups will have the same post-operative protocol; mainly having a urethral catheter, that will remain in situ from several hours up to 5 days depending on the density of the urethral stricture.
 
Follow up:
 
Anonymized and coded participants in both groups will have their first post-operative follow-up with an independent and “blinded” clinician, in two weeks, one month, three months, six months, and one year respectively. The follow-up will entail clinical assessment along with UroFlow rate measurement.
 
Results:
 
Once analyzed, the results will be written, presented at conferences, and will be published.
 

Summary:

The future of medicine ( and I dare to say that the possible demise of surgery!) lies in the development and application of stem cells to treat and possibly cure patients with various conditions.

However, as exciting as it seems, this application is quite novel, at least in many medical and surgical specialities, and it’s the application will have to be carried out within a reach, ethics, and Governance framework.

Once properly applied, the prospects are endless

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



Testosterone Treatment; pros and cons

Posted on by Dr. Ali Thwaini

Testosterone, a steroid hormone, helps maintain muscle, bone, and libido. Men in their 4th decade (mid-30s), begin to have less testosterone in their bodies, at an average of just under 2% per year. If that drop continues, it could lead to hypogonadism or low testosterone. This happens to 20% of men in their 60s.

Also, Metabolic syndrome; an increasingly common condition, and testosterone deficiency in men, are closely Linked. Studies have shown that Low Testosterone Levels are associated with obesity, insulin resistance, and an adverse Lipid profile in men.

Metabolic syndrome and Low testosterone are associated with increased all-cause and cardiovascular events.

Replacement of testosterone to its physiological levels produces improvement in insulin resistance, obesity, lipid derangement, and eventually sexual dysfunction along with the improved quality of Life. However, there is little evidence on the effect of testosterone replacement on mortality in men with Low Testosterone Levels.

Testosterone Replacement Therapy (TRT) aims to boost those low levels in men with T deficiency. But TRT has had its advantages and disadvantages.

Testosterone and hypertension:

Derangements in lipid metabolism play a pivotal role in the formation of atherosclerotic plaque. High total cholesterol and LDL-C are proatherogenic whereas high HDL seems to be protective against atherosclerosis. The same pathogenic process is also implicated in the development of metabolic syndrome and type 2 diabetes although elevated total cholesterol and LDL-C are not part of the definition of metabolic syndrome. Declining levels of testosterone with age is associated with a relative increase in oestrogen levels through the increased aromatase activity. The increased oestrogen levels are associated with increased circulating cholesterol and more atherogenic lipoprotein particles.


A number of studies have shown a negative correlation between testosterone levels and total cholesterol and LDL-C. A meta-analysis of 19 clinical trials in hypogonadal men reports that significant reductions in total cholesterol and LDL-C is associated with intramuscular TRT.

Studies have shown that low testosterone levels are associated with known hypertension. Conversely, men with anabolic steroid abuse are known to have an increased risk of developing hypertension.

Testosterone and Atherosclerosis:

Low testosterone level is associated with the presence of atherosclerosis. A 4-year follow-up study demonstrated that low testosterone led to increased deterioration of the atherosclerosis. This provides evidence to support the hypothesis that testosterone deficiency promotes the pathogenesis of atherosclerosis.

Testosterone Replacement Therapy (TRT) – FAQ

Are there other than low testosterone that explains sexual dysfunction?


 Yes. Low libido and erectile dysfunction, for example, have many contributing factors to rule out, including heart disease and psychological issues.

When would I know my Testosterone Replacement Therapy is helping?

Your doctor should confirm within 6 months or so whether TRT has improved your symptoms. If it hasn’t, discuss ending treatment.

Will TRT affect my ability to father children?

Yes. TRT decreases sperm production potentially affecting Men’s fertility. Upon stopping TRT, fertility will likely return. In a small number of men, infertility is permanent.

Are there other “natural” measures to elevate my testosterone?


Reducing weight ( in overweight men) and resistance exercises may help boost your levels without medication.

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