Relationship between serum vitamin D levels semen parameters and sperm DNA damage in men with unexplained infertility.

OBJECTIVE: The aim of the study was to investigate the relationship between serum level of vitamin D, semen analysis parameters and sperm DNA damage in men with unexplained subfertility. PATIENTS AND METHODS: Fifty-eight men diagnosed with unexplained infertility and 50 age and BMI matched fertile men were included in the study. A participant whose semen parameter is normal but pregnancy is not achieved was accepted as unexplained male infertility. Blood samples were taken from all participants following three-day abstinence for measurement of vitamin D. Sperm DNA damage was assessed by Aniline Blue staining of the collected samples. RESULTS: Compared with the fertile men, male patients with unexplained infertility had significantly lower vit D levels (27.00 ng/mL (12.63-39.30) vs. 23.66 ng/mL (7.50-55.00), p<0.004). While the number of patients with vitamin D levels lower than 20 ng/mL was 26 (44.8%) in the infertile group, it was recorded as 5 (10.0%) in the fertile group (p<0.001). DNA damage was found in 31.50% (9.0-71.0) of the infertile men and 26.00% (11.0-54.0) of the fertile men. DNA damage was found to be significantly higher in the unexplained infertile group (p<0.002). In men with unexplained male infertility, serum vit D levels were positively correlated with total sperm count (r = 0.527, p<0.001), total motility (r = 0.527, p<0.001) and sperm morphology (r = 0.416, p = 0.001). There was a negative and significant correlation between vit D levels and sperm DNA damage (r = -0.605, p<0.001). In the logistic regression analysis, serum vit D > 20 ng/mL led to an improvement in fertility outcome. CONCLUSIONS: Men with unexplained infertility exhibit decreased serum vit D levels and increased sperm DNA damage.

Role of endothelin receptors and relationship with nitric oxide synthase in impaired erectile response in diabetic rats.

To evaluate the protective role of bosentan (BOS), an endothelin-1 (ET-1) receptor antagonist, and to show the changes in rats with experimentally induced diabetic erectile dysfunction (ED), a total of 24 albino Wistar rats were allocated into four groups. Group 1 was the healthy group and Group 2 had diabetes mellitus (DM) induced by intraperitoneal injection of 60 mg kg-1 streptozotocin (STZ). Following the establishment of DM, Group 3 and Group 4 were treated with oral BOS doses of 50 mg kg-1 and 100 mg kg-1 , respectively, for 60 days. At the end of the treatment, we evaluated yawning and erection response to apomorphine treatment and then the animals were sacrificed. ET-1, eNOS, iNOS, tumour necrosis factor (TNF)-α, ET-RA and ET-RB mRNA expressions were analysed in cavernosal tissue. It was observed that yawning and erection response decreased in the diabetic group; however, both of these improved with BOS treatment. While ET-1, TNF-α and iNOS gene expressions increased, eNOS, ET-RA and ET-RB gene expressions decreased in the DM group compared to the healthy group. DM has a negative impact on cavernosal tissue blood flow through activating vasoconstrictor mediators in cavernosal tissue. BOS regulates significantly eNOS, iNOS and TNF-α expressions in a dose-dependent manner.

Two clinical problems in elderly men: osteoporosis and erectile dysfunction.

Seventy-six of 108 random men aged 50 years or over were evaluated for erectile dysfunction with interviews of patients using the International Index of Erectile Function Form and minimal evaluation. Serum hormone concentrations were measured. Bone mineral density was measured using dual energy x-ray absorptiometry. Hormone levels did not show significance in terms of erectile dysfunction or bone mineral density results. Erectile dysfunction was determined in 57 (75%) of 76 patients. Ten (13.2%) patients had osteoporosis and 45 (59.2%) had osteopenia at the bone mineral density measurements. The distribution of bone mineral density groups relating to erectile dysfunction did not show significance. The frequencies of osteoporosis and erectile dysfunction increased with age, but the association of these conditions seems to be independent of each other and hormonal changes appear not to be the major determinants for both conditions in elderly men.

Effect of seminal plasma calcitonin levels on sperm mobility.

This study investigated the effect of the seminal and blood plasma calcitonin levels on the sperm motility in idiopathic infertile patients. The number of sperm cells and their motility were evaluated in the spermiograms of 52 idiopathic infertile patients. The levels of seminal plasma calcitonin were studied with double antibody technique using a DPC kit. Fifty-two patients were divided into 2 groups according to the motility rates of sperm and 20 healthy volunteers were assigned to a control group. The difference between the groups was evaluated by using Kruskall-Wallis and Mann-Whitney U tests, and the correlation of seminal and blood calcitonin levels with sperm motility were determined. The difference in motility rates between the 3 groups was statistically significant (p = .000, p < .05). Blood plasma calcitonin levels were in normal ranges in all cases and no significant difference was found among the 3 groups (chi2 = 2.7219, p = .2589, p > .05). While sperm motility was correlated with seminal calcitonin levels (r = .8581), blood calcitonin levels did not show a correlation with sperm motility rate (r = -.0265). Moreover, there was no correlation between seminal and blood plasma levels of calcitonin (r = -.0010). Motility rates decreased in the patients with low seminal calcitonin levels and seminal calcitonin levels had a significant effect on sperm motility.

Short-term histopathologic effects of different intracavernosal agents on corpus cavernosum and antifibrotic activity of intracavernosal verapamil: an experimental study.

OBJECTIVES: To evaluate the short-term effects of different intracavernosal agents and to investigate the antifibrotic effect of verapamil combined with these intracavernosal agents. METHODS: Forty-five Sprague-Dawley rats weighing 400 to 500 g each (mean weight 435.27 +/- 13.65 g) were equally divided into nine groups (n = 5). Papaverine (group 1), alprostadil (group 2), sodium nitroprusside (group 3), and verapamil (group 4) were injected alone intracavernously in 0.2-mL doses. Verapamil combined with papaverine, alprostadil, and sodium nitroprusside in 0.2-mL doses (0.1 mL verapamil and 0.1 mL vasoactive agent) were injected in groups 5 through 7. Group 8 was kept as a control group without injection, and isotonic saline alone was injected in group 9 during the same period. The intracavernous injection was done twice weekly with a 4-day interval. At the end of the study, total penectomy and multiple liver biopsies were performed to evaluate the histopathologic effects of the vasoactive agents and to test the liver function. RESULTS: In all groups, the structure of the corpora cavernosa was well preserved generally and appeared similar to the control tissue. However, localized edema, fibrosis, macrophage infiltration, and polymorphonuclear leukocytes were found only at the injection site. Although these findings were not different from the findings in the saline and alprostadil groups, they were slightly more extensive in the papaverine and sodium nitroprusside alone groups and also in the vasoactive agent plus verapamil groups. Although mononuclear lymphocyte infiltration was found in the portal areas, advancing into the liver parenchyma, the liver function tests were within normal limits. CONCLUSIONS: We observed that intracavernous injection, except with nitroprusside, caused focal intracavernosal fibrosis and edema. We believe these effects might not be caused by just the drug, but also by needle trauma, since general fibrosis was not observed in the short term. However, nitroprusside has a severe fibrotic effect on cavernosal tissue in the short term. Moreover, intracavernous verapamil injection could not prevent the fibrosis in the short term.

The efficacy of alfuzosin treatment in patients with prostatism.

OBJECTIVE: Alfuzosin, a quinazoline derivative, is a selective alpha-la adreneceptor antagonist with further selectivity for the alpha-1 adrenoceptors of the lower urinary tract and lesser affinity for vascular alpha-1 adrenoceptors. The present study evaluates the efficacy of alfuzosin in a group of the patients with prostatism. METHODS: Eighty-two patients with lower urinary tract symptoms aged from 55 to 76 years (mean age 62.36 +/- 6.4) were enrolled in the study. The patients were evaluated by blood pressure measurement, digital rectal examination, serum total and free prostate specific antigen (PSA) determinations by Tandem R-Assay with the reference range of 0.0 to 4.0 ng/ml, international prostate symptom score (IPSS), volume measurement by transrectal prostate ultrasound, blood biochemistry, uroflowmetry, postvoiding residual urine (PVRU) assessment. The patients treated with alfuzosin 2.5 mg three times a day for 3 months were re-evaluated by blood pressure measurement, IPSS, urine flow rate (UFR) and PVRU assessment in the 2nd week and in the 6th week, and by blood pressure measurement, IPSS, blood biochemistry, serum total and free PSA determinations, UFR and PVRU assessment in the 3rd month. Statistical analysis was performed using student-t test, and p value was considered significant when less than 0.05. RESULTS: Although IPSS significantly decreased in the 2nd week of the treatment compared to pre-treatment value, it reached a maximum decrease in the 6th week of the treatment. There were statistically significant difference between in the 2nd week IPSS value and the 6th week IPSS value. However, no difference was seen between the 6th week IPSS value and the 3rd month IPSS value. No significant difference was observed between pre-treatment values and the 2nd week values regarding UFR and PVRU. Peak flow rate and PVRU significantly changed in the 6th week of the treatment and they reached maximum change in the 3rd month. Difference was also significant between the values in the 6th week of the treatment and those in the 3rd month of the treatment. According to the blood biochemical analysis, total and free PSA levels before and after the treatment, there were no significantly difference. Additionally, alfuzosin had no effect on blood pressure. Before, during and after the treatment, blood pressure did not change significantly. CONCLUSION: Present study showed that symptomatic improvement with alfuzosin treatment began in the 2nd week, reaching the maximum level in the 6th week whereas urodynamic parameters began to improve in the 6th week and reached the maximum level in the 3rd month with no effect on blood pressure and blood biochemical test.

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: is it a useful test?

BACKGROUND: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. METHODS: Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. RESULTS: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). CONCLUSION: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.

Comparison of the efficacy of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation.

OBJECTIVE: The present study compares the efficacy and side effects of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation. METHODS: Forty-three patients suffering from premature ejaculation were studied. The exclusion criteria were erectile dysfunction, loss of libido, alcohol and substance abuse, mental retardation, diabetes mellitus, thyroid disease, hypotension, previous use of these drugs and urogenital infections. The patients' ages ranged from 19 to 48 years (mean age 28 +/- 1.6). They had regular sexual lives. They had normal psychiatric consultation and the Glombock Rast Sexual Satisfactory Test (GRISS) psychiatric test were in accordance with premature ejaculation. RESULTS: The patients were assigned to two groups. Twenty-six patients, aged 21 to 36 years (mean age 27), received only fluoxetine 20 mg/day (1 capsule) for a week which was later increased to 40 mg/day (2 capsules). Seventeen patients, aged 19 to 48 years (mean age 31), were given fluoxetine 20 mg/day plus local application of lidocaine ointment. The patients and partners were re-evaluated 8 weeks after the treatment. The results were classified as unsuccessful, improvement and cure. The chi-square test was used for statistical analysis. In the fluoxetine group, 8 (30.8%) patients cured, 11 (42.2%) showed improvement and there were 7 failures (26.9%). In the combination treatment group, 9 (52.9%) patients cured, improvement was observed in 5 (29.4%) and failure in 3 (17.6%). Side effects in group I were observed in 6 patients (23%) and in 5 (29.4%) in group II. There were no statistical differences between the two groups according to the side effects (p > 0.01). No patients were excluded from the study due to side effects. CONCLUSION: The combination of fluoxetine plus local application of lidocaine ointment was found to be more effective than fluoxetine alone in the treatment of premature ejaculation. However, the results should be confirmed in further studies with a placebo group to rule out the placebo effect.

The comparison of the incidence of horseshoe kidney in autopsy cases versus urologic patient population.

This study was applied on 9665 cases between January 1993 and October 1998. Of these, 6985 (72.3%) were urologic patients and 2680 (27.7%) were autopsy cases. The patients having urinary complaint investigated by urine analysis and kidney-ureter-bladder film (KUB), routinely. In all patients who have pathological urine, ultrasonography exam was done and in all patients who established an abnormality on ultrasonography, intravenous pyelography (IVP) was taken, also. We established the horseshoe kidney in 23 of patients (1/304) and in 6 of autopsy cases (1/447) with overall incidence 1/333. There were 21 male and 8 female with horseshoe kidney (male/female = 2.6/1). Abdominal discomfort with lower lumbar pain and Rovsing's sign were seen in 56.5% and in 65.2% of patients respectively. We concluded that horseshoe kidney incidence is almost the same as reported in the literature, although its clinical appearance is higher in our urologic patient population. In the urological out-patient evaluation, at least Rovsing's sign should be applied to all patients with lower lumbar pain with vague abdominal discomfort and an abdominal ultrasonographic exam should be applied, if this sign is positive.

Electrical activity of the corpus cavernosum in denervated rats.

BACKGROUND: We evaluated the electrical activity of the corpus cavernosum after intracavernous papaverine injection in rats that had been denervated experimentally. METHODS: Twenty-four male adult Sprague Dawley rats were divided into three groups: (i) controls (n=8) (ii) unilateral cavernous nerve resection on the right side (n=8); and (iii) bilateral cavernous nerve resection (n=8). Through a suprapubic incision, the urinary bladder was retracted laterally to locate the major pelvic plexus on the lateral surface of the prostate. The major branch of the cavernous nerve, running caudally from the pelvic plexus, was isolated and excised using an operating microscope. Three weeks later, recording of the electrical activity of the corpus cavernosum (EACC) was performed by using a Neuropack-2 EMG unit (Nihon Kohden, Tokyo, Japan) and coencentric needle electrode. Changes in amplitude were evaluated before and after intracavernosal papaverine injection. The results in the flaccid state and after papaverine injection were compared by using the Mann Whitney U-test in all three groups and paired t-test between groups. RESULTS: In the flaccid penis, the mean (+/- SD) amplitude of electrical activity of the corpus cavernosum was 17.42+/-2.05, 12.42+/-1.88, 9.71+/-1.59 and 5.85+/-0.96 microV in control rats, in unilaterally denervated rats (in which the cavernous nerve was intact on the left side), in unilaterally denervated rats in which the cavernous nerve was resected on the right side and in bilaterally denervated rats, respectively. In the flaccid state, EACC is lower in the bilaterally denervated group than in the control and unilaterally nerve-resected groups (P < or = 0.05). The recording of electrical activity of the corpus cavernosum was continued for 20 min after papaverine injection. In the control group and in both groups of unilaterally denervated rats, we observed a significant decrease in the electrical activity of the corpus cavernosum in the first 5 min after papaverine injection (P < or = 0.05). However, no difference was observed in bilaterally denervated rats after injection (P > or = 0.05). CONCLUSIONS: We conclude that electrical activity of the corpus cavernosum continues after unilateral nerve injury in rats. Cross-innervation may play a role in penile innervation and corpus cavernosum electromyography shows electrical activity in denervated rats.

Histopathological changes and nitric oxide synthase activity in corpus cavernosum from rats with neurogenic erectile dysfunction.

OBJECTIVE: To investigate changes in histology and nitric oxide synthase (NOS) activity in cavernosal tissues from rats with neurogenic erectile dysfunction induced experimentally. MATERIALS AND METHODS: Twenty-four adult male Sprague-Dawley rats were divided equally into three groups and underwent a sham operation (control, group 1), unilateral (group 2) or bilateral (group 3) cavernosal nerve resection. Three months later they were killed and the cavernosal tissues analysed histologically by light and transmission electron microscopy, with NOS activity detected using an NADPH-diaphorase staining technique. RESULTS: On light and electron microscopy, while penile nerves and cavernosal smooth muscle cells had a normal morphological appearance in the eight control rats, there were degenerative changes of the myelinated penile nerves and axonal fibrosis in groups 2 and 3. However, these changes were not significant. Using NADPH-diaphorase staining, NOS activity was detected in all three groups in endothelial cells and cavernosal structures. However, the staining was more intense in endothelial cells and cavernosal muscles of rats in group 2 than in the other groups. CONCLUSION: NOS activity was increased in the cavernosal tissue after cavernosal denervation, but the pharmacological action of nitric oxide may be impaired.

A case of hydatid disease with unusual localizations.

All organs in the human body may suffer from hydatid disease. Urinary tract involvement in hydatid disease is not common including only 2-4% of cases. The kidneys are the most commonly affected organs in the urinary tract, with other organs rarely affected alone. We report a case of hydatid disease presented with acute urinary retention due to retrovesical hydatid cyst, together with a communicating renal hydatid cyst and a cyst in the right gluteal muscle.

Comparative study between corpus cavernosum-electromyography findings and electron microscopy of cavernosal muscle biopsies in erectile dysfunction patients.

BACKGROUND: Biopsy and electrical activity recordings of the corpus cavernosum are 2 new diagnostic methods for the evaluation of impotent men. We evaluated the corpus cavernosum ultrastructure and electromyography (EMG) recordings from patients with erectile dysfunction. METHODS: Twenty erectile dysfunction patients with veno-occlusive dysfunction underwent a detailed history, physical examination, biochemical tests, hormonal analysis, injection of an intracavernous vasoactive agent (60 mg papaverine-HCl), color penile Doppler ultrasonography, cavernosometry/ cavernosography and corpus cavernosum electromyography (CC-EMG). Thirteen patients underwent total vein ligation and 7 had penile prosthesis implantations. Tissue samples were obtained during surgery from both corpora cavernosa and examined by transmission electron microscopy. Control corporal tissue samples were taken from 3 cadavers. RESULTS: In 15 patients, CC-EMG recordings were 15.6 +/- 0.65 microV in the flaccid state, which decreased in 13 patients after papaverine (5.61 +/- 0.25 microV; P < 0.001). Five patients with diabetes mellitus had low amplitudes in the flaccid state (5.26 +/- 0.45 microV), which did not vary significantly after a papaverine injection (4.99 +/- 0.75 microV). The pathology of the corpus cavernosum biopsy specimens revealed a smooth muscle cell thickened basal membrane, dilated rough endoplasmic reticulum, and increased numbers of fibroblasts, but ultrastructurally normal endothelial cells lining the sinusoids. There was no difference between samples from diabetic or nondiabetic patients, or from either side of the corpora cavernosa. The only pathologic change observed in the controls was mitochondrial swelling. CONCLUSION: CC-EMG is less invasive and a valuable method in patients with erectile dysfunction, whereas no specific findings were observed from penile biopsy specimens.

The effect of age in the usage of alpha receptor blocker treatment in prostate patients.

Age was considered in the usage of alpha receptor blocker in the treatment of prostate patients. Ninety patients with prostatism were treated with alpha 1 receptor blockers (Doxazocin 4 mg/day) for 8 weeks. Before and after treatment, the patients in two groups according to their age, above and below 60 years, were evaluated using International Prostate Symptom Score (IPSS). The patients younger than 60 years of age had more significant relief compared to those older than 60 years of age.