Summary Introduction:  Erectile dysfunction (ED) is a highly prevalent condition affecting nearly one in five men worldwide. The advent of phosphodiesterase type 5 inhibitors (PDE5i) has revolutionised the ED treatment landscape and provided effective, minimally invasive therapies to restore male sexual function. Materials and methods:  A pubmed search was performed of all English language articles from 1996 to present reviewing PDE5i, including pharmacokinetics, efficacy profiles and comparisons, where available. Results:  Currently available PDE5i in the United States include sildenafil, vardenafil, tadalafil and avanafil, each of which has unique side effect, pharmacokinetic and outcome profiles. Sildenafil is associated with increased rate of visual changes, vardenafil with QT prolongation and tadalafil with lower back pain. Avanafil and vardenafil orodispersible tablet rapidly achieve peak plasma concentration, which results in faster onset of action, whereas tadalafil exhibits the longest half‐life. First time response to PDE5i is approximately 60–70%, with no significant differences in efficacy noted among therapies. The literature does not clearly demonstrate a preference for one drug. High‐treatment success rates (89%) were reported when patients were prescribed all available PDE5i. Daily dosing with tadalafil is associated with improved erectile function (EF) over time. Finally, novel modes of patient–provider interaction, including internet‐based education, communication and prescribing, may also improve long‐term adherence. Conclusions:  PDE5i represent first line therapy for ED with excellent overall efficacy and satisfactory side effect profiles. Enhanced communciation, coupled with increased knowledge of drug characteristics, comparative treatment regimens and optimal prescribing patterns, offer compelling tools to improve long‐term treatment success.

SUMMARYPeyronie's disease (PD) is a localized connective tissue disorder that involves the tunica albuginea (TA) of the penis. While surgical correction remains the gold standard, the search for an effective and less invasive therapy continues. The objective of this study was to evaluate the effects of intratunical injection of adipose tissue-derived stem cells (ADSCs) for the prevention and treatment of erectile dysfunction in a rat model of PD. Twenty-four male Sprague-Dawley rats (300-350 g) were randomly divided into four groups: sham, PD, PD + ADSC (prevention) and PD + ADSC (treatment). All rats underwent penile injections into the TA with 50 lL vehicle (sham) or 0.5 lg transforming growth factor (TGF)-b1 (remaining groups). The ADSC groups received intratunical injections with 0.5 million rat-labelled ADSCs on day 0 (prevention) or day 30 (treatment). Forty-five days following TGF-b1 injection, rats underwent cavernous nerve stimulation (CNS) with total intracavernous-to-mean arterial pressure ratio (ICP/MAP) and total ICP recorded to measure response to therapy. Tissues were evaluated histologically and for mRNA expression of tissue inhibitors of metalloproteinases (TIMPs), matrix metalloproteinases (MMPs) and zymographic activity of MMPs. Statistical analysis was performed by analysis of variance followed by the Tukey test for post hoc comparisons. In both prevention and treatment groups, intratunical injection of ADSCs resulted in significantly higher ICP/MAP and total ICP in response to CNS compared with the PD group. Local injection of ADSCs prevented and/or reduced Peyronie's-like changes by decreasing the expression of TIMPs, and stimulating expression and activity of MMPs. This study documents the preventive and therapeutic benefits of ADSC on penile fibrosis and erectile function in an animal model of PD.

SUMMARYThe aim of this study was to evaluate interrelation of left varicocoele with height, body mass index (BMI) and sperm counts. We retrospectively evaluated the data of all patients who consulted for infertility at a tertiary academic referral centre from 2000 to 2010. Patient's height, weight, BMI, semen analysis, presence or absence of varicocoele and varicocoele side and grade were evaluated. In statistical evaluations chi-square, student's t, Mann-Whitney U, ANOVA and logistic regression analyses were performed. In ANOVA analyses, Bonferroni post hoc test was performed when needed. The data of 1842 among 2780 men, presenting for infertility, were included in the study. There were 587 men (31.9%) with left varicocoele and 1255 (68.1%) men without varicocoele. Two hundred and seventy-two men (14.8%) had grade I or II, and 315 men (17.1%) had grade III varicocoeles. Mean height was 174.3 ± 6.7 and 172.5 ± 7.0 cm in men with and without varicocoele respectively (p < 0.001). The mean BMI of cases without varicocoeles (25.8 kg/m 2 ) was greater than varicocoele group (24.9 kg/m 2 ) (p < 0.001). Percentage of varicocoele was the highest in moderately oligozoospermic males and significantly higher than the men with normal sperm count. As the height increased, the probability of having varicocoele increased, and the inverse is true for BMI. If varicocoeles are a progressive lesion, perhaps taller men with varicocoeles should be followed more closely to evaluate their fertility and androgenic status.

Thymoquinone is the major active component derived from Nigella sativa. Methotrexate is a folic acid antagonist widely used in clinic. Aim of this study was to investigate the possible protective role of thymoquinone on testicular toxicity of methotrexate. Experiments were performed on male C57BL/6 mice (6 weeks old, 20 ± 2 g). The animals were divided into four groups with six mice in each group. Equivalent volumes of saline were injected intraperitoneally (i.p.) in the control group. In the thymoquinone group, mice received thymoquinone i.p. with a dose of 10 mg/kg/day for 4 days. Mice in the methotrexate group received single dose of methotrexate i.p., with a dose of 20 mg/kg. Finally, in the methotrexate plus thymoquinone group, in the first and the following 3 days after methotrexate administration, thymoquinone was injected with a dose of 10 mg/kg/day, i.p. At the end of the experiment, the left testis was quickly removed and divided into two parts for histological examination and biochemical analysis. Methotrexate alone increased total antioxidant capacity and myeloperoxidase activity compared to the controls. Thymoquinone treatment decreased total antioxidant capacity and prevented the increase in the myeloperoxidase activity. Light microscopy showed in mice that receiving methotrexate resulted in interstitial space dilatation, edema, severe disruption of the seminiferous epithelium and reduced diameter of the seminiferous tubules. Administration of thymoquinone reversed histological changes of methotrexate significantly. We suggest that thymoquinone use may decrease the destructive effects of methotrexate on testicular tissue of patients using this agent.