Introduction Recent studies suggest a direct relationship between free testosterone and cavernous vasodilatation. Some men with erectile dysfunction (ED) associated with PADAM (partial androgen deficiency in aging men) might possibly benefit from testosterone undecanoate therapy (TRT). Objectives To determine the efficacy of testosterone undecanoate in facilitating the erectile response and patient satisfaction with sildenafil in men 40–70 years old with PADAM symptoms. Design and Methods Prospective study including 40 patients recruited after a sildenafil therapeutic trial. Total testosterone and sex hormone binding globulin (SHBG) were measured to calculate the free androgen index. Prostate specific antigen (PSA) was measured and repeated 2 months after treatment. A rating score was used for PADAM symptoms, and the 5-point abbreviated version of the International Index of Erectile Function (IIEF-5) to assess erectile function. Men failing to respond to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT (group 1ST), and TRT (group 1T) alone. Men partially responding to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT for 2 months (group 2ST), or sildenafil alone (group 2S). Treatment efficacy was assessed by analysis of between-group differences. Results Groups 1T, 2S, and 2ST showed significant improvement in PADAM scores (P < 0.05, Wilcoxon matched pairs test). Patients receiving both sildenafil plus continuous TRT (groups 1ST and 2ST) showed significant improvement in IIEF-5 scores (P < 0.5, paired t-test). No significant changes in serum levels of PSA were detected (paired t-test). Conclusions We conclude that TRT appears to be beneficial and safe in facilitating the erectile response and patient satisfaction with sildenafil in men with PADAM symptoms. Androgen supplementation should be carried out cautiously with careful monitoring to avoid possible adverse effects.

Introduction Premature ejaculation (PE) is regarded as the most common male sexual disorder. Previous studies reported that prostatic inflammation was highly prevalent in PE. However, the effect of antibiotic treatment of cases with PE and chronic prostatitis has not been extensively investigated. Aim To examine the effect of antibiotic treatment in delaying ejaculation in patients with PE and chronic prostatitis. Methods A total of 145 consecutive men attending of secondary premature ejaculation (SPE) were included in this study. Sequential microbiologic specimens were obtained from urine and prostatic fluid. Antibiotics were given for 1 month according to the results of their culture and sensitivity test. All patients were instructed to follow up with our clinic monthly for at least 4 months. At the end of the 4-month follow-up, another prostatic secretion analysis was performed. Results Based on expressed prostatic secretion culture and white blood cell (WBC) count, 94 (64.8%) were having chronic bacterial prostatitis. The remaining 51 (35.2%) patients had negative WBC count. Of the 94 patients with SPE and chronic bacterial prostatitis, 20 patients were left untreated and considered as a control group. All 74 patients with PE and chronic prostatitis continued the 1-month treatment duration. Following 1-month antibiotic treatment, all 74 patients with initially positive cultures had sterile final cultures (P < 0.05). Sixty-two (83.9%) patients showed increases in their ejaculatory latency time and reported good control of their ejaculation and were considered treatment responsive. None of the control group patients experienced any improvement either in their prostatic infection condition or in their ejaculation time. The follow-up of treatment-responsive patients (N = 62) revealed no recurrence of PE with negative prostatic culture. Conclusion Successful eradication of causative organisms in patients with PE and chronic prostatitis may lead to marked improvement in intravaginal ejaculatory latency time and ejaculatory control.

Introduction: In order to accurately assess the extent of chronic pelvic pain syndrome (CPPS) and to objectively measure symptoms for natural history studies and to assess the outcome parameters for clinical trials, the National Institutes of Health (NIH) Chronic Prostatitis Collaborative Research Network developed and validated the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). The aim of the current study was to develop and validate a fluent and comprehensive Arabic version of the NIH-CPSI. Methods: This study consisted of 80 consecutive male patients affected by CPPS and 80 healthy controls who were asked to complete the Arabic version of the NIH-CPSI. The translation was performed by a group consisting of an andrologist and professional translators. Psychometric data were collected. Results: Of the 160 subjects enrolled, 82 (50 patients and 32 controls) completed the study. The total Arabic NIH-CPSI scores and the scores of each subscale differed significantly between the two groups with good discriminant validity. The questionnaire had also a high internal consistency. Conclusion: The present study provides the Arabic version of the NIH-CPSI and recognizes it as a valid and reliable tool in the assessment of local patients with CPPS.

Objective The aim of our work is to evaluate the efficacy of intracavernous sodium nitroprusside (SNP) in management of erectile dysfunction (ED) in a clinical comparative study with papaverine/phentolamine in ED patients. Methods The study included 40 patients with ED divided into two groups. Group I include 20 patients receiving intracavernous (30 mg papaverine + 1 mg phentolamine) followed 1 week later by intracavernous 300 µg SNP. Group II included 20 patients receiving the same regimen of group I but with intracavernous SNP first followed by papaverine/phentolamine 1 week later. All patients were assessed clinically for their response and any developing complications. Results The numbers of good and poor responders were not statistically significant (P > 0.05) among the two groups. The mean erectile duration of SNP was similar to bimix (P > 0.05). No side-effects whether local or systemic occurred with SNP while priapism and local penile pain were recorded with bimix solution. Conclusions Intracavernous pharmacotherapy is still a reliable method both for diagnosis and for treatment of ED. While preliminary results of our study show a potential of SNP to be an effective and safe intracavernous agent, long-term self-injection clinical trials are needed before large-scale usage is recommended.

This study aimed to evaluate the effectiveness of ICI of platelet‐rich plasma (PRP) in addition to daily oral tadalafil intake in diabetic erectile dysfunction (ED) patients non‐responding to PDE5 inhibitors. Overall, 48 patients complaining of ED non‐responding to on‐demand PDE5 inhibitors were allocated into 2 equal groups, diabetics and non‐diabetics that were given a daily dose of 5 mg tadalafil plus vardenafil 20 mg on demand during the study besides being subjected to 3 doses of ICI of PRP, 4 weeks apart. Responses to on‐demand PDE5 inhibitors, International index of erectile function‐5 (IIEF‐5) score, erection hardness scores (EHS) and pharmaco‐dynamic duplex studies were assessed. After PRP injections, 33% and 50% of cases were satisfied with on‐demand PDE5 inhibitors, respectively, whereas 41% and 66% of them showed improved EHS response. Compared with baseline scores, the mean IIEF‐5 scores were significantly improved after PRP therapy in the diabetic ED group (12.1 vs. 8.04, p = 0.003) as well as in the non‐diabetic ED group (14.8 vs. 10.2, p = 0.001) linked to pharmaco‐penile duplex readings. Both good and fair diabetic control exhibited significant responses to ICI therapy of PRP compared with bad controlled cases. The significant improvement included; the IIEF‐5 score increase (86.7%, 126% vs. 16.1%), improved EHS as well as penile duplex readings. Baseline HbA1C demonstrated a significant negative correlation with IIEF‐5 score before (p = 0.019) and after PRP therapy (p = 0.002) respectively. It could be concluded that ICI of PRP could be an effective therapy for treating ED patients non‐responding to on‐demand oral PDE5 treatment.