Relationships between levels of estradiol and testosterone in seminal plasma and GSTM1 polymorphism in infertile men.

Glutathione S-transferase M1 (GSTM1) enzyme serves as a steroid-binding protein by its ability to bind to testosterone and estradiol. The levels of total estradiol and testosterone were measured by using an electrochemiluminescence immunoassay in serum and seminal plasma from 103 subjects including 62 subfertile patients. GSTM1 polymorphism was examined using polymerase chain reaction. The estradiol and testosterone levels in seminal plasma were not different in control and subfertile subjects. No role for GSTM1 enzyme as a steroid-binding protein seemed likely as there was also no significant difference in seminal plasma estradiol and testosterone levels according to GSTM1 genotype. Significant positive correlations were found between seminal estradiol and serum estradiol in infertile males, and between seminal testosterone and serum testosterone in fertile males, independent of GSTM1 genotype. GSTM1 polymorphism is not a genetic risk factor of seminal estradiol and testosterone levels in infertile males although further studies are warranted.

Incision and venous patch graft in the surgical treatment of penile curvature in Peyronie's disease.

OBJECTIVES: To assess the efficacy of incision and venous patch grafting method in the surgical treatment of the curvature in Peyronie's disease. METHODS: Fifty-eight patients with Peyronie's disease underwent incision of the tunica albuginea with Peyronie's plaque(s) and venous patch grafting between 1994 and 1999. Segment(s) of lower saphenous vein in 48, deep dorsal vein in 7, and upper saphenous veins were used in 3 cases as venous patch(es). Assessment of the potency status, curvature, and vascular structure were performed pre-operatively with detailed history, counselling, autophotography, and color Doppler ultrasonography. Realistic expectations from the surgery was discussed with the patients in advance. Postoperative evaluation was performed at least twice, in the 6th week and the 3rd month. The third evaluation was done in 12-36 months by telephone. RESULTS: Fifty of the patients (86%) achieved straight erections after the surgery. Five patients (9%) had improvement in their penile curvature that enabled them to perform sexual intercourse easily. In 3 of our patient (5%) recurrence of the curvature was observed. Penile shortening of 0.5-1.5 cm was observed in 13 of the cases (22.4%). Fifty-four cases (93%) reported no change in their quality of erections. CONCLUSION: Incision of the tunica albuginea and venous patch grafting technique is a very satisfactory surgical method in the treatment of the curvature in Peyronie's disease.

Apoptosis in the erectile tissues of diabetic and healthy rats.

OBJECTIVE: To compare the frequency of apoptosis in the erectile tissue of chronic diabetic and healthy rats. MATERIALS AND METHODS: Fourteen chronic diabetic and 10 healthy Sprague-Dawley rats were killed, their penises harvested and stored at -70 degrees C until staining and flow cytometric analysis for apoptosis. A cell suspension was obtained from the penile tissue by scraping the inside of the cavernosum with a scalpel and filtering through a mesh. Samples of the cell suspension (0.5 x 106 cells) were stained with Annexin V (an indicator of apoptosis) and propidium iodide (PI, which stains dead cells), incubated for 15 min at room temperature and analysed by flow cytometry. The DNA content was also analysed in each sample. RESULTS: In normal erectile tissue, a mean of 6.2% of cells were stained with Annexin V, while only 2.7% were stained with PI; DNA content analyses showed 7.5% were hypodiploid cells. In diabetic rats 19.5% of cells were stained with Annexin V and 5.2% with PI; 22.9% of cells were hypodiploid. CONCLUSION: The ratio of apoptotic cells in the erectile tissues of diabetic rats was significantly greater than in normal rats. The high rate of apoptosis in diabetic rats may play a role in the pathophysiology of erectile dysfunction.

Patient-partner satisfaction with intracavernous medication supported with oral agents in selected cases of Peyronie's disease. A ten-month follow-up study.

We attempted to find the most adequate treatment option for some selected cases of Peyronie's disease. Between 1993 and 1996, 38 patients with Peyronie's disease and erectile dysfunction were treated with intracavernous medication, supported with oral colchicine and vitamin E. None of the cases had severe angulation of penis and intolerable pain during erection. Quality of sexual life was assessed by CWRU questionnaire. After ten-month follow-up we found improvement in all parameters, in CWRU. The symptoms of 24 cases diminished. The 21 partners examined were also satisfied with the therapy. We conclude that intracavernous medication combined with oral agents is a useful alternative treatment in selected cases of Peyronie's disease.

Retrospective analysis of medicolegal cases and evaluation for erectile function.

Erectile function (EF) is an important question in lawsuits for divorce, rape, and damages. In this study, a method to evaluate medicolegal cases is defined, and the characteristics of the 265 cases screened for EF between 1989 and 1997 were analyzed. Interview, physical examination, psychometric evaluation, nocturnal penile tumescence, serum hormone levels and blood chemistry, intracavernosal drug injection, penile Doppler ultrasonography, and pharmacocavernosometry and pharmacocavernosography tests were used for diagnosis. The tests performed were selected according to the age of the subject. Of the 265 cases 128 (48.3%) were for divorce, 116 (43.7%) were for rape, and 21 (8%) were for indemnity relating to lawsuits for damages. In only 7 cases (2.7%) was the defendant <15 years of age. Organic pathology for erectile dysfunction (ED) was present in 22% of lawsuits for divorce, 40.5% of lawsuits for rape, and 33.4% of lawsuits for damages. Three men in cases of divorce and 2 men after genital trauma due to traffic accident suffered psychological ED. This study indicates that lawyers may abuse the assertion of ED in lawsuits for divorce and rape. In 128 divorce cases the defendant was accused of being impotent, but evaluation proved that 75.8% had normal EF. In lawsuits for rape, 59.5% of defendants had normal EF although the lawyers of the rapist claimed their clients were impotent. The investigation, interpretation, and characteristics of medicolegal cases may differ in countries with different cultures.

New derivatives of benzimidazole and their antimicrobial activity.

Azolium salts and neutral 2-aryl derivatives of benzimidazole, benzothiazole and benzoxazole were synthesized and compounds were identified by 1H and 13C NMR spectroscopy and microanalytical methods. In this work the salts 1 and the neutral compounds 2 were evaluated for their in vitro antimicrobial activity against standard strains: Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC 29213), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Candida albicans and Candida tropicals. The compounds 1f, 1g, 1l, 1m, 1n, 2a, 2b, 2c, 2e, 2f showed antimicrobial activity against Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC 29213), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Candida albicans and Candida tropicals, with minimum inhibitory concentrations (MICs) ranging between 50 to 200 mg/mL. Compounds 1f, 1g, 1l, lm, 2b, 2c showed the highest activity. Benzothiazolium and benzoxazolium salts were more active than 1,3-disubstituted benzimidazolium salts and neutral 2-substituted benzimidazole, benzothiazole and benzoxazole derivatives.

The value of serum prostate specific antigen and other parameters in detecting bone metastases in prostate cancer.

The cut-off value of serum prostate-specific antigen (PSA) level in prediction of bone metastases and the correlation of serum PSA with the clinical stage, grade, score and the rate of bone metastases have been investigated in cases of prostate cancer (PCa). The study population consisted of 160 patients with histologically proven PCa between April, 1993 and August, 1996. The negative predictive value and the sensitivity were the highest (94%) in patients with a serum PSA value less than 10 ng/ml. We claim that in patients with PSA values less than 10 ng/ml whole body bone scan is not necessary.

Repetition of color Doppler ultrasonography: is it necessary?

The aim of the study was to determine whether any difference would occur in peak systolic velocity (PSV) and end diastolic velocity (EDV) measurements of color Doppler ultrasonography (CDU) between proximal and distal segments of the cavernous arteries obtained at different times. Twenty-six cases have undergone CDU three times in weekly intervals. PSV and EDV measurements of cavernous arteries were obtained both proximally and distally. The results have shown that statistically there was no difference between each measurement obtained on either sides at three different tests. (ANOVA PSV F(2-50) = 0.63, EDV F(2-50) = 0.81). Four of the 26 cases had different PSV results and six cases had different EDV results in three CDU tests. There was a statistical difference in measurements between proximal and distal segments of the cavernous arteries. (t-test t = 2.53, P = 0.015) In conclusion, repetition of CDU would not be necessary in majority of the cases. However investigators should always be aware and cautious about falsely abnormal results of CDU. Proximal segments of the cavernous arteries should be the site to obtain true CDU measurements.

The relationship between diabetes mellitus, impotence and veno-occlusive dysfunction in Peyronie's disease patients.

Peyronie's disease is an ill-defined condition that often leads to severe penile deformity and sometimes erectile dysfunction. Penile Doppler studies indicate veno-occlusive dysfunction as the principal cause of poor rigidity in Peyronie's disease patients. Diabetes mellitus is also a known cause of impotence and its prevalence tended to be higher in patients with Peyronie's disease. We evaluated 143 patients with Peyronie's disease, also 92 impotent men (37 diabetic, 55 nondiabetic) as control group. Penile vascular studies were performed on each group. Diabetes mellitus was also investigated in patients with Peyronie's disease. Veno-occlusive dysfunction was found as the main cause of impotence in both groups (81.1% in diabetic, 89% in nondiabetic control group and 88.8% in Peyronie's disease patients). In our study group the prevalence of diabetes mellitus tended to be higher than in the control population but it did not alter the ratio of veno-occlusive dysfunction and impotence in Peyronie's disease patients. We believe there is a close relationship between diabetes mellitus and Peyronie's disease, considering our high incidence. We also conclude that diabetes mellitus is not the main cause of impotence in patients with Peyronie's disease.

Management of buried penis in adults.

Buried penis is rarely managed in adults. Two patients with buried penis were treated at 18 and 20 years of age. An autolog split-thickness graft was used for covering the dermal defect of the penis. Results were successful without any evidence of postoperative complications.

An unusual presentation of a foreign body in the urinary bladder: A migrant intrauterine device.

A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.

Superficial dorsal penile vein thrombosis (penile Mondor's disease).

In our center between 1992 and 1994 penile Mondor's disease (superficial dorsal penile vein thrombosis) was diagnosed in 5 patients aged 20-39 years. In all patients the thromboses were noted 24-48 hours after a prolonged sexual act with or without an intercourse. the main symptom was a cord-like thickening of the superficial veins, which were painless or slightly painful. Doppler examination of the superficial dorsal vein revealed obstruction of the vessels. In 2 patients the retroglandular plexus was also involved. Patients were treated with anti-inflammatory medications (Tenoxicam or Ibuprofen). The resolution of the thrombosis occurred uneventfully within 4-6 weeks. No recurrence or erectile dysfunction was noted in any of the patients. Penile Mondor's disease is a benign pathology of the superficial dorsal penile vein and should be taken into account in the differential diagnosis of penile pathologies.

Our experience with pharmacological erection treatment of erectile dysfunction.

Administration of vasoactive drugs intracavernously is a well-known easily used and inexpensive alternative in treatment of a certain group of patients with erectile dysfunction. There are a few drugs used for this purpose, but we prefer papaverine as the first choice because it is easily available and inexpensive in our country. We used alprostadil only in nonresponders to papaverine or if there was any complication with papaverine. We present a series of 69 patients, 24 with psychogenic (34.8%), 27 with organic (39.1%), and 18 (26.1) with mixed etiology of erectile dysfunction, treated with intracavernous self-injection therapy. Mean follow-up of the patients was 13.6 months (7-30 months). In this study, 3,430 papaverine and 780 alprostadil injections were performed in 56 and 13 patients, respectively. In 75% of the papaverine injections and in 83% of the alprostadil injections, erections were achieved sufficient for sexual intercourse. During the follow-up, there were not any abnormal alterations in liver function tests. The main complaint of the patients who used papaverine was a burning sensation (98%) during administration of the drug, which did not last more than 1 minute. Of 13 patients in the alprostadil group, 56.9% of the patients complained mainly of discomfort during erection. We concluded that intracavernous therapy is a good and inexpensive option in the management of erectile dysfunction in carefully selected patients.

Update evaluation of benign prostatic hyperplasia: when should we offer prostatectomy?

OBJECTIVE: To investigate correlations between traditional and urodynamic criteria in the evaluation of prostatism and to try to establish an update evaluation of patients with benign prostatic hyperplasia (BPH) with the aim of preventing unnecessary prostatectomies. PATIENTS AND METHODS: The series constituted 96 patients aged 43-86 years (mean 63.41 +/- 9.25) with prostatism and BPH. All were assessed by symptom analysis, digital rectal examination, residual urine determination, uroflowmetry and further multichannel urodynamic testing (medium fill cystometry, pressure flow study). RESULTS: Residual urine determination was not a reliable criterion for selection of patients for surgery. A striking statistically significant correlation was evident when symptomatology and the results from multichannel urodynamic study were compared. No correlation was found between irritative symptoms and detrusor instability. CONCLUSION: A significant proportion (23%) of the whole patient population was classified as a urodynamically unobstructed group to which we think prostatectomy should not be offered. We recommend that a pressure-flow study is performed in all patients with BPH with dominant irritative symptoms to identify those who are unobstructed.