Lower Urinary Tract Symptoms Correlate with Erectile Dysfunction and Premature Ejaculation but Not with Men's Sexual Activity: Results from a Large Population-Representative Study.

BACKGROUND: Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men's sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. METHODS: We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. RESULTS: All included men were representative in relation to their age and residential location (n = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS (p < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, p < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961-1.001, p = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. CONCLUSION: LUTS worsened ED and PE but had no impact on men's sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT05462171).

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

INTRODUCTION: Internal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. METHODS: The data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. RESULTS: In all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. CONCLUSION: In our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU.

Effect of Serum Vitamin B12 Levels on Premature Ejaculation.

OBJECTIVE: To assess the impact of vitamin B12 levels in the failure of the dapoxetine used in premature ejaculation (PE) treatment. STUDY DESIGN: Experimental study. Place and Duration of the Study: Andrology Clinic, between May and December 2020. METHODOLOGY: Patients with premature ejaculation complaints completed the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire. Patients were also asked to fill in the Premature Ejaculation Profile (PEP) surveys. Intravaginal ejaculation latency time (IELT) were recorded based on the estimates of patients. Serum vitamin B12 levels were evaluated based on blood samples. All patients were advised to use dapoxetine 30 mg, 1-3 hours prior to intercourse. After four weeks, patients were asked to complete the PEP questionnaire again. IELT times were recorded. RESULTS: A total of 62 patients were included in the study. A total of 39 patients (62.90%) were satisfied with the treatment of the dapoxetine. In comparison to patients who benefited from dapoxetine treatment and those who did not, vitamin B12 levels of patients who did not benefit from dapoxetine were found to be significantly lower (p=0.005). CONCLUSION: Vitamin B12 deficiency can reduce the effectiveness of dapoxetine treatment in patients with PE. It is important to evaluate serum vitamin B12 levels for the evaluation of patients with PE. KEY WORDS: Premature ejaculation, Dapoxetine, Vitamin B12, Serotonin, Treatment.

Overactive bladder negatively affects erectile function and promotes premature ejaculation: findings from large representative population-level study.

PURPOSE: The effect of overactive bladder (OAB) on sexual health has been evaluated extensively for women but much less for men. Therefore, the aim of this study was to evaluate the relationship between OAB and men's sexual activity and the effect of OAB on erectile dysfunction (ED) and premature ejaculation (PE) in a large representative cohort of men at the population level. METHODS: This study was based on computer-assisted web interviews that used validated questionnaires. The most recent census and the sample size estimation calculations were employed to produce a population-representative pool. RESULTS: The study included 3001 men, representative of the population in terms of age and place of residence. The frequency of sexual intercourse was higher for respondents without OAB symptoms compared with persons who had OAB (p = 0.001), but there was no association between OAB symptoms and number of sexual partners (p = 0.754). Regression models did not confirm the effect of OAB on sexual activity (odds ratio 0.993, CI 0.974-1.013, p = 0.511). Both ED and PE were more prevalent in respondents with OAB symptoms compared with persons who lacked those symptoms (p < 0.001). Importantly, the effect of OAB on ED or PE was independent of age, comorbidities, and lifestyle habits (regression coefficients of 0.13 and 0.158 for ED and PE, respectively). CONCLUSION: Overactive bladder did not significantly affect men's sexual activity, but it significantly correlated with ED and PE. Our results suggest a need in daily clinical practice to screen for OAB symptoms for persons who report ED or PE.

The effect of long-term COVID-19 on aetiological factors related to nocturia.

AIMS AND OBJECTIVES: This study was conducted to examine the possible aetiology of nocturia in patients with long-term COVID-19. BACKGROUND: Physical and neuropsychiatric symptoms, an increase in overactive bladder symptoms, especially from urinary system complaints, has been reported in patients with COVID-19, 10-14 weeks after the illness. DESIGN: A descriptive design. METHODS: The study consisted of 70 patients who had experienced COVID-19, had nocturia, and were followed in the State Hospital between April and July 2022. Data were collected using a patient information form, the 'TANGO' nocturia screening tool, and the Visual Analog Scale. This study was created in accordance with the STROBE Statement Checklist. RESULTS: When the nocturia effects of long-term COVID-19 were examined it was determined that the urinary tract was the 'priority' aetiological condition. It was observed that there was a significant difference between the aetiological factor groups in terms of the mean age of the patients and the number of nocturia (p < .05). According to post-hoc analysis, the mean age of patients with a dominant cardio-metabolic factor was found to be significantly younger (p < .05). In addition, when comparing the number of nocturia according to the aetiological factors of the patients, it was observed that the number of nocturia was significantly frequent in the patients with a dominant sleep factor (p < .05). CONCLUSIONS: It was found that the urinary tract aetiological factor was dominant in patients with long-term COVID-19 and nocturia, patients with a dominant cardiovascular aetiological factor were younger, and that the number of nocturia was higher in patients with a dominant sleep factor. RELEVANCE TO CLINICAL PRACTICE: Identification of the early signs and symptoms and underlying causes of nocturia in individuals with post-COVID-19 syndrome will enable nurses and health professionals to guide the early identification of different underlying problems, as well as the implementation of approaches to treat and eliminate nocturia. PATIENT OR PUBLIC CONTRIBUTION: The patients contributed to the study by agreeing to participate in the evaluation of nocturia complaints after COVID-19 infection.

Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology.

The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were 'robotic assisted', 'ureteric reimplantation', 'cystoplasty', 'ileal conduit', 'neobladder', 'sacrocolpopexy', 'colposuspension', 'artificial urinary sphincter', 'genitourinary fistula' and 'posterior urethral stenoses'. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.

The Effect of Running Water Sound Listened to Patients During Urodynamics on Anxiety and Urodynamic Parameters.

PURPOSE: This study was conducted to determine the effect of listening to the sound of running water during urodynamics on the patient's anxiety and parameters in the pressure-flow study. METHODS: The population of the study, which was planned in the nonrandomized experimental study design, consisted of patients who will undergo urodynamics in the Urology Department of a city hospital in Istanbul between September 2022 and January 2023, and the sample consisted of 60 patients, 30 of which were in the experimental group and 30 in the control group. During the pressure-flow study, the patients in the experimental group listened to the sound of running water from a smartphone, while the patients in the control group did not undergo any intervention during urodynamics. The level of anxiety in both groups before, during and after urodynamics was evaluated with the visual analogue scale. During the pressure-flow study, it was evaluated whether the patients emptied on command, and the maximum flow rate (Qmax) and the detrusor pressure at the maximum flow rate (PdetQmax) were measured. Bladder outlet obstruction index (PdetQmax-2Qmax) and bladder contractility index (Pdetqmax+5Qmax) were calculated using these values. RESULTS: During the pressure-flow study, in the experimental group patients who listened to the sound of running water from a smartphone; anxiety level mean scores during and after urodynamics were found to be statistically significantly lower than the control group patients (P < 0.001). The mean bladder contractility index score in the experimental group patients was statistically significantly higher than the control group patients (P < 0.001), and the cases of urinating with a catheter during the pressure-flow study were statistically significantly higher than the control group patients (P < 0.001). CONCLUSION: Listening to the sound of running water during urodynamics had a positive effect on reducing anxiety in patients and micturating during pressure-flow study.

The prevalence and topographic distribution of penile calcification in a large cohort: a retrospective cross-sectional study.

The prevalence of penile calcification in the population remains uncertain. This retrospective multicenter study aimed to determine the prevalence and characteristics of penile calcification in a large cohort of male patients undergoing non-contrast pelvic tomography. A total of 14 545 scans obtained from 19 participating centers between 2016 and 2022 were retrospectively analyzed within a 3-months period. Eligible scans (n = 12 709) were included in the analysis. Patient age, penile imaging status, presence of calcified plaque, and plaque measurements were recorded. Statistical analysis was performed to assess the relationships between calcified plaque, patient age, plaque characteristics, and plaque location. Among the analyzed scans, 767 (6.04%) patients were found to have at least one calcified plaque. Patients with calcified plaque had a significantly higher median age (64 years (IQR 56-72)) compared to those with normal penile evaluation (49 years (IQR 36-60) (p < 0.001). Of the patients with calcified plaque, 46.4% had only one plaque, while 53.6% had multiple plaques. There was a positive correlation between age and the number of plaques (r = 0.31, p < 0.001). The average dimensions of the calcified plaques were as follows: width: 3.9 ± 5 mm, length: 5.3 ± 5.2 mm, height: 3.5 ± 3.2 mm, with an average plaque area of 29 ± 165 mm² and mean plaque volume of 269 ± 3187 mm³. Plaques were predominantly located in the proximal and mid-penile regions (44.1% and 40.5%, respectively), with 77.7% located on the dorsal side of the penis. The hardness level of plaques, assessed by Hounsfield units, median of 362 (IQR 250-487) (range: 100-1400). Patients with multiple plaques had significantly higher Hounsfield unit values compared to those with a single plaque (p = 0.003). Our study revealed that patients with calcified plaques are older and have multiple plaques predominantly located on the dorsal and proximal side of the penis.

Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired).

OBJECTIVE: The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety. METHODS: Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36). RESULTS: The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group. CONCLUSIONS: Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients' quality of life also negatively affects their depression and anxiety states.

Is there a relationship between mean platelet volume and response to treatment with daily tadalafil in patients with erectile dysfunction?

Mean platelet volume (MPV) has been related to erectile dysfunction (ED). However, its value in predicting therapeutic response to phosphodiesterase-5 inhibitors is not evaluated. This study aimed to investigate the value of MPV as a marker for the prediction of the response of the tadalafil treatment of ED. A retrospective analysis of patients who were admitted to the andrology outpatient clinic between 2020-2022 were performed. The inclusion criteria were, ≥40 years old male, International Index of Erectile Function-Erectile Function domain score < 26, not received any ED treatment before, have a stable heterosexual relationship, and prescribed 5 mg daily tadalafil for primary treatment of ED. A total of 116 patients were included in the study. The mean age of the patients was 53.7 ± 8.7 years. The response rate to 5 mg tadalafil treatment was 52.6% (Group-1; N = 61). An MPV value 3 10.05 fL was associated with 66% sensitivity and 75,4% specificity for no response to 5 mg daily tadalafil treatment (Area under curve = 76.9% [95% CI 68.2%-85.6%; p < 0.001]). Initial IIEF-EF score, fasting blood glucose, and MPV level was independently associated with the response to the tadalafil treatment. This is the only study to evaluate the value of MPV level on the therapeutic response of ED to tadalafil. Strict inclusion criteria were applied to the cohort. However, the diagnose of vascular ED has been made by clinical evaluation and retrospective design of the study were the limitations of the study. The results of our study suggest that MPV might be used to predict the result of 5 mg daily tadalafil treatment in selected ED patients as a fast and cost-effective test.

Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired)

SUMMARY OBJECTIVE: The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety. METHODS: Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36). RESULTS: The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group. CONCLUSIONS: Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients' quality of life also negatively affects their depression and anxiety states.

The effect of vitamin D replacement in patients with lower urinary tract complaint/erectile dysfunction resistant to Tadalafil 5 mg treatment: A pilot clinical study.

The aim of this study was to evaluate the effect of vitamin D replacement in patients with lower urinary tract symptoms (LUTS)/erectile dysfunction (ED) who did not respond to tadalafil 5 mg treatment. Patients who applied to the Andrology Clinic with LUTS/ED between September 2017 and August 2020 and used 5 mg Tadalafil daily for treatment and did not benefit from treatment for 1 month were included in the study. Vitamin D levels of the patients were analysed and Vitamin D3 100,000 IU/week oral therapy was administered for a month to the patients with low levels of Vitamin D(<20 ng/ml).The values of the patients before and after Vitamin D replacement were compared. A total of 84 patients were included in the study. The mean age was 49.175 ± 11.63(28-70) years and the mean BMI was 25.93 ± 6.82(18.26-37.87). Testosterone levels of the examined patients were 3.45 ± 0.99 ng/ml. After 1 month of Vitamin D replacement + Tadalafil 5 mg/d treatment, the international index of erectile function-erectile function (IIEF-EF) (pre-treatment: 10.73 ± 6.12, post-treatment: 24.18 ± 4.87; p = 0.001) and International Prostate Symptom Score (pre-treatment: 9.12 ± 7.16, post-treatment: 3.11 ± 1.08; p = 0.003) scores of the patients improved significantly. Evaluation of Vitamin D levels is important to improve treatment response, especially in patients who do not respond to PDE-5 inhibitors.

Impact of combined usage of questionnaire forms with bladder diary for overactive bladder syndrome.

PURPOSE: Bladder diary and questionnaire forms have an important role in the diagnosis of overactive bladder (OAB) syndrome and can predict response to OAB treatment. We aimed to evaluate the correlation between three different validated Turkish OAB questionnaires and bladder diary form. METHODS: Patients aged over 18 years who admitted to the urology outpatient clinic with OAB symptoms between March 2019 and April 2020 were enrolled into the study. Demographic data of the patients were recorded, and they were asked to complete a 3-days bladder diary. In addition, the patients filled Turkish validated OAB version-8 (OABv8), the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), and OAB Symptom Score (OABSS) questionnaire. The relationship between these questionnaire forms and bladder diary was evaluated with statistical analysis. The significant p was p < 0.05. RESULTS: A total of 592 patients were included in the study. The mean total points of the questionnaire forms were 22.07 ± 8.34 (0-38) for OABv8, 10.78 ± 7.21 (0-21) for ICIQ-SF, and 9.36 ± 3.53 (0-15) for OABSS, respectively. There was a positive poor correlation between OABv8 questionnaire form and nocturia (r = 0.287, p = 0.013). There was a positive moderate correlation between OABSS and the number of micturition (r = 0.405, p = 0.03) and nocturia (r = 0.508, p = 0.036), and the urgency incontinence was negatively moderate correlations (r = -0.525, p = 0.041). CONCLUSION: Both questionnaire forms and bladder diaries are important in the evaluation of OAB patients. According to our results the bladder diary and OABSS questionnaire forms were interrelated.

The validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction.

This study aims to assess the validity and reliability of the Turkish version of the FSFI-6 questionnaire,an abbreviated version of FSFI-19,a common tool for evaluating female sexual function. The study included 120 female patients aged between 18-65 years who presented to the urology clinic between December 2019 and March 2020. The Turkish version of FSFI-6 was translated from the English version for validation. The abridged FSFI-6 questionnaire consists of questions 2, 4, 7, 11, 16, and 17 of the FSFI-19 form. We recorded the demographic data of the patients. All subjects filled out the FSFI-19 and FSFI-6 questionnaires. The patients were asked to fill out the questionnaires again after two weeks. The mean age of the subjects was 46.58 ± 9.89 years (28-63). The results of the reliability analysis indicated that the intraclass correlation coefficient of the total FSFI-6 score was 0.92 (weighted kappa coefficients of individual items, 0.868-0.975) and the Cronbach's alpha was 0.862. The validity analysis indicated that the mean total FSFI-6 score was strongly correlated with the mean FSFI-19 score (p < 0.001, r = 0.997). In the test-retest analysis,the kappa coefficient was calculated as 0.891. The FSFI-19 and FSFI-6 scores of the patients with (n = 52) and without climacturia (n = 68) were compared, and it was observed that the scores of the patients with climacturia were significantly lower than those without climacturia (p < 0.001). The abbreviated FSFI-6 questionnaire is a valuable tool for screening women with FSD. It can be used more extensively due to being short and easy to apply. Our results approve the Turkish version of the questionnaire as a valid and reliable tool for evaluating FSD.

The effect of Mirabegron and Duloxetine combination in mixed-type urinary incontinence treatment.

OBJECTIVE: Stress-type and urgency-type urinary incontinence are seen together in mixed-type urinary incontinence. Treatment is usually chosen according to the predominant type of incontinence. The aim of this study is to evaluate the effect of mirabegron and duloxetine combination in the treatment of mixed-type urinary incontinence. METHODS: The data of 88 mixed-type urinary incontinence patients who applied to the urology outpatient clinic between January 2018 and December 2019 were retrospectively analyzed. We applied mirabegron and duloxetine treatment to the patients. The International Consultation of Incontinence Questionnaire-Short Form, Overactive bladder symptom score questionnaire and daily pad count were statistically evaluated before and after the treatment. RESULTS: Statistically significant improvements were observed using the questionnaire forms and decreased daily pad usage after the eight-week treatment (p<0.001). Based on the clinical global effect scale, 62.50% of patients had a partial or complete response to treatment and also the use of daily pads were decreased from 3.7-0.89 on an average. CONCLUSION: Combination use of mirabegron and duloxetine in the treatment of mixed-type urinary incontinence improved symptom scores and decreased pad usage.

The impact of myasthenia gravis on lower urinary tract functions.

AIM: To assess the functions of the lower urinary tract (LUT) in patients with myasthenia gravis (MG). MATERIALS AND METHODS: A total of 36 patients (18 males and 18 females) with MG and 29 healthy controls were enrolled. Participants completed a 3-day voiding diary and responded to questionnaires "Overactive Bladder Symptom Score" (OABSS) and "International Consultation on Incontinence-Short Form" (ICIQ-SF). All patients underwent uroflowmetry and ultrasonography (US). The data were compared based on the onset of disease and serological status. RESULTS: The most common urinary symptoms were nocturia (80.5%), incontinence (61%) and urgency (47%). OABSS was higher in patients than controls (P = .008). Duration of urinary symptoms was longer, and nocturia was more common in late-onset MG (LOMG) than in early-onset MG (EOMG; P = .029, P = .023). The duration of disease and urinary symptoms statistically increased in ACh-Ab (-) group compared with ACh-Ab (+) group (P = .003, P = .027). Night-time urination frequency significantly increased while daytime voided volume (VV) decreased in LOMG compared with EOMG (P = .003 and P = .01). Residual volume on the US was significantly higher in LOMG than that in EOMG (P = .004). The duration of disease was positively correlated with tQmax and daytime urination frequency (P = .013, r = .48; P = .016, r = .398). A negative association was found between duration of disease and daytime VV (P = .04, r = -.344). CONCLUSION: LUT dysfunction may manifest disease in MG, particularly in late-onset forms. The lack of ACh-Ab seemed to prolong the duration of disease and urinary disturbances.

Relation of glycated hemoglobin and vitamin D deficiency with erectile dysfunction in patients with type 2 diabetes mellitus.

Erectile dysfunction (ED) is seen very often in the men with type 2 diabetes mellitus (DM). Due to the ability of vitamin D to reduce endothelial damage and oxidative stress, its role in preventing cardiovascular risk has been demonstrated in some studies. Since ED and cardiovascular disease have common pathogenic mechanisms, many studies have evaluated a possible relationship between vitamin D deficiency and ED. Total 120 patients with type 2 diabetes mellitus were evaluated in this study. Vitamin D and HbA1c values were statistically compared according to International Index of Erectile Dysfunction (IIEF-5) scores. 23.3% of 120 patients had mild, 38.3% had mild to moderate, 21.7% had moderate and 16.7% had severe ED. There was statistically difference in vitamin D levels of the patients according to IIEF-5 scores. Also, significant difference was found in HbA1c levels between the patients with severe ED and other groups. Cut-off point for vitamin D and HbA1c were determined according to IIEF-5 score in patients who were divided in to two groups (14.41 and 11.1). A statistically significant correlation was found between both cut-off points and IIEF-5 scores. Our study shows that patients with ED have a vitamin D deficiency and a poor glycemic control.

The Effect on Pain and Anxiety of Hot Pad Applied to Patients During Transrectal Prostate Biopsy.

AIM: The aim of the study was to evaluate the effect of the application of a heating pad on the sacral region on pain and anxiety during a transrectal prostate biopsy. DESIGN: This was a quasi-experimental study. METHODS: The quasi-experimental study was conducted in the Urology Outpatient Clinic of a Training and Research Hospital in Istanbul. A total of 40 males were nonrandomly divided into two groups: experimental group (n = 20) and control group (n = 20). A heating pad (40-45°C) was applied to the sacral region of the patients in the experimental group during transrectal prostate biopsy. Data were collected using the Beck Anxiety Inventory (BAI) and visual analogue scale (VAS). RESULTS: It was detected that the mean scores of the BAI were significantly lower in the experimental group compared with the control group (p < .001). The scores of the VAS were significantly lower in the experimental group compared with the control (p = .016). CONCLUSION: Applying a heating pad to the sacral region during a transrectal prostate biopsy is an effective non-pharmacologic method to increase patient comfort and reduce pain and anxiety.