Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl.

Despite the benefits of spinal anesthesia and the preference of anesthesiologists for this technique, it is less accepted by urologists due to the proximity of the stone place in the ureter and the possibility of pain, restlessness, and occasional movements of the patient during surgery. The current study investigated the success of bupivacaine plus intrathecal fentanyl in patients undergoing transurethral lithotripsy (TUL). In this randomized clinical trial, from April 2021 to September 2021, 54 patients with proximal urolithiasis candidates for TUL were enrolled. Patients were randomly categorized into two groups: group A received bupivacaine 10 mg and 0.5 ml of normal saline, while group B received bupivacaine 10 mg with 0.5 ml (25µg) of intrathecal fentanyl. According to our findings, about 74% of the patients were men, and the mean age of the patients was 66.14±22.46 years. The onset time of the sensory block, sensory block level, pain score, degree of relaxation, depth of the motor block, occurrence of anesthesia complications, oxygen saturation, and mean arterial blood pressure were not significantly different between the two groups. However, the duration of the motor block in group B was longer than in group A (p<0.001). Also, retropulsion was observed only in five patients (18.5%) in group A, significantly higher than in group B (p=0.019). Bupivacaine with fentanyl 25µg provided adequate spinal anesthesia with lower retropulsion in patients with urolithiasis who are candidates for TUL.

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study.

Background: Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. Objectives: This study aimed to investigate the risk factors of bleeding in PNL. Methods: This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. Results: The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Conclusions: Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial.

BACKGROUND: Several medical therapies have been proposed for the treatment of premature ejaculation (PE). Paroxetine and tramadol were both reported to be effective in treatment of PE. In this study, the therapeutic effects of tramadol, paroxetine and placebo were compared in treatment of primary PE. METHODS: In this randomized, double-blind, placebo-controlled clinical trial, 150 patients were divided into 3 groups. One group was treated with tramadol 50 mg ondemand, the other group took paroxetine 20 mg on-demand and the third group was treated with placebo. Before starting treatment and after 12 weeks, patients were asked to measure their average intravaginal ejaculation latency time (IELT) and fill the PEP (Premature Ejaculation Profile) questionnaire. RESULTS: At the end of the 12th week, the mean IELT and average of PEP scores improved in all 3 groups. The increase in tramadol group was significantly higher than the paroxetine and placebo groups (p<0.0001). There were no significant differences in terms of side effects between the 3 groups. CONCLUSION: The results showed that despite an increase in mean IELT and PEP scores in all 3 groups, the rate of improvement in tramadol group was significantly more than the others. Thus, tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE.

Urinary Beta-2Microglobulin: An Indicator of Renal Tubular Damage after Extracorporeal Shock Wave Lithotripsy.

PURPOSE: This study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damageand the affecting factors by measuring urinary beta2microglobulin (ß2M) excretion. MATERIALS AND METHODS: This is a cross-sectional study conducted on 91 patients with renal stones who underwentESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure foreach patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubularinjury. RESULTS: Mean ± SD urinary beta2-microglobulin values, before and after ESWL were 0.08 ± 0.07 and 0.22 ± 0.71mg/dL respectively, the average difference between which was equal to 0.14 ± 0.07 mg/dL. These figures exhibiteda 166.66% rise in the urinary ß2M concentration after ESWL which was statistically significant (P < .001). Multivariateanalysis showed that hypertension (P = .05) and the history of ESWL (P = .02) were predictive factors ofhigher post-ESWL urinary beta2-microglobulin excretion. CONCLUSION: Urinary excretion of beta2-microglobulin increased significantly immediately after ESWL. Thesechanges could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patientswith hypertension and a previous history of ESWL the likelihood of this injury is higher than others.

Application of bland-altman method in comparing transrectal and transabdominal ultrasonography for estimating prostate volume.

BACKGROUND: Estimating prostate volume using less invasive transabdominal ultrasonography (TAUS) instead of transrectal ultrasonography (TRUS) is of interest in terms of identifying their agreement level. Previous reports on this subject, applied general correlation coefficient as the level of agreement. This study uses Bland-Altman method to quantify TAUS and TRUS agreement on estimating prostate volume. METHODS: Total prostate gland volume of 40 patients with signs and symptoms of benign prostatic hyperplasia were measured using TAUS and TRUS. The study was carried out at the Urology Research Center, Razi Hospital, Guilan University of Medical Sciences (Rasht, Iran) from March to October 2010. Both methods were performed in one session by the same experienced radiologist. Data were analyzed using Pearson correlation coefficient and Bland-Altman method. RESULTS: Total prostate volume estimated by TAUS and TRUS were 50.30±23 and 50.73±24.6 mL, respectively. The limits of agreement for the total prostate volume were -6.86/9.84 that was larger than predefined clinical acceptable margin of 5 mL. CONCLUSION: There is a lack of agreement between TAUS and TRUS for estimating the total prostate volume. It is not recommended to apply TAUS instead of TRUS for estimating prostate volume.

Real-time scrotal ultrasound of patients with varicoceles: correlation with impaired semen analysis.

OBJECTIVES: To evaluate the potential relationship between scrotal ultrasound findings and abnormal semen analysis. METHODS: Eighty-seven patients with varicoceles underwent semen analysis and scrotal sonography. On ultrasound, estimated testes volume and the largest pampiniform vein diameters on the affected side at rest and with Valsalva manoeuvre in both the supine and upright positions were examined. In addition, the differences between the largest venous diameters at rest and during the Valsalva manoeuvre in each position (supine and upright) and also the differences between the largest venous diameter in the supine position and the upright position in each condition (at rest and during the Valsalva manoeuvre) were calculated. The relationship between various ultrasound parameters and impaired semen analysis was evaluated using receiver operating characteristic curves. RESULTS: Seventy-one patients had spermatogenesis impairment, and the remaining 16 had normal semen analysis. The difference in the mean spermatic vein diameter at rest between the supine and upright positions (cut-off point, 0.25 mm) had the highest diagnostic accuracy in differentiating the patients with abnormal sperm analysis from those with normal spermatogenesis with an area under the curve of 0.86. CONCLUSIONS: Real-time scrotal ultrasound can be helpful in predicting abnormal sperm analysis in patients with varicoceles. KEY POINTS: Scrotal ultrasound is a non-invasive method to evaluate spermatic veins in varicoceles. Ultrasound can evaluate venous dimension change at rest after upright position (ΔD(R) ). ΔD( R) > 2.5 mm distinguishes patients with abnormal semen analysis. ΔD( R) has the most accuracy in predicting abnormal spermatogenesis. Ultrasound findings improve differentiation between patients with abnormal and normal spermatogeneses.

Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study.

PURPOSE: Urinary retention is one of the most common complications contributing to surgical procedures. Recent studies have shown the benefits of alpha-adrenergic blockers in preventing post-operative urinary retention (POUR). The aim of this prospective study was to compare the prophylactic effect of tamsulosin with placebo on postoperative urinary retention. MATERIALS AND METHODS: In this randomized placebo controlled, clinical trial, 232 male patients aged 18 to 50 years old admitted to Razi University Hospital for varicocelectomy, inguinal herniorrhaphy, and scrotal surgery were randomly assigned to receive either three doses of 0.4mg tamsulosin (n = 118) or placebo (n = 114), 14 and 2 hours before, and 10 hours after surgery. Patients were closely monitored for the development of urinary retention 24 hours after surgical intervention. The primary endpoint was to investigate the effect of tamsulosin in prevention of post-operative urinary retention during the first 24 hours after surgical intervention. Collected data were analyzed using SPSS software version 18 and the P < 0.05 was considered statistically significant. RESULTS: One hundred and eighteen patients were included in tamsulosin arm and 114 in placebo arm. POUR in patients who received tamsulosin was significantly lower than placebo, as 5.9% of the patients treated with tamsulosin and 21.1% placebo group, reported urinary retention following surgery (P = 0.001). No serious adverse effects were seen in both groups. CONCLUSIONS: This study suggests that short perioperative treatment with tamsulosin can reduce the incidence of urinary retention and the need for catheterization after varicocelectomy, inguinal herniorrhaphy, and scrotal surgery.

Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study

Purpose: Urinary retention is one of the most common complications contributing to surgical procedures. Recent studies have shown the benefits of alpha-adrenergic blockers in preventing post-operative urinary retention (POUR). The aim of this prospective study was to compare the prophylactic effect of tamsulosin with placebo on postoperative urinary retention. Materials and Methods: In this randomized placebo controlled, clinical trial, 232 male patients aged 18 to 50 years old admitted to Razi University Hospital for varicocelectomy, inguinal herniorrhaphy, and scrotal surgery were randomly assigned to receive either three doses of 0.4mg tamsulosin (n = 118) or placebo (n = 114), 14 and 2 hours before, and 10 hours after surgery. Patients were closely monitored for the development of urinary retention 24 hours after surgical intervention. The primary endpoint was to investigate the effect of tamsulosin in prevention of post-operative urinary retention during the first 24 hours after surgical intervention. Collected data were analyzed using SPSS software version 18 and the P < 0.05 was considered statistically significant. Results: One hundred and eighteen patients were included in tamsulosin arm and 114 in placebo arm. POUR in patients who received tamsulosin was significantly lower than placebo, as 5.9% of the patients treated with tamsulosin and 21.1% placebo group, reported urinary retention following surgery (P = 0.001). No serious adverse effects were seen in both groups. Conclusions: This study suggests that short perioperative treatment with tamsulosin can reduce the incidence of urinary retention and the need for catheterization after varicocelectomy, inguinal herniorrhaphy, and scrotal surgery. .

Retroperitoneal ganglioneuroma mimicking right adrenal mass.

Ganglioneuroma is a rare benign tumor of the sympathetic nervous system that can arise from the adrenal medulla. Few reports have been published of the surgical resection of this rare tumor using a laparoscopic approach. We present a case of retroperitoneal ganglioneuroma that mimicked an adrenal mass on imaging and was resected laparoscopically.

Focal neuropathies following percutaneous nephrolithotomy (PCNL)--preliminary study.

INTRODUCTION: Postoperative neurological complications in pelvic and renal surgery are a well-known clinical problem and their morbidities are important. We designed this study to determine prevalence and risk factors of such complications after percutaneous nephrolithotomy (PCNL) surgery. MATERIAL AND METHODS: A cross-sectional study was performed during February and July 2011 on 68 PCNL cases. Demographic data and surgery reports were gathered and comprehensive neurological physical examination carried out before and after surgery. Then, data was analyzed using software SPSS 18. RESULTS: The ultimate sample included 30 (46.2%) male and 35 (53.8%) female patients with a mean age of 47.9 ± 11.47 years. In intercostal and lumbosacral plexus area, sensory neurological complications occurred in 8 patients (12.31%), 4 men and 4 women. The most common involved dermatomes and nerves were T12 (8 cases). There was a significant correlation between prolonged duration of surgery and prevalence of sensory complications (p<0.010). The highest hemoglobin value drop after surgery occurred in patients with neurological complications (p<0.001). There were no correlations between age, tracts used, diabetes mellitus, BMI, hypertension, positioning of patients and side of surgery with incidence of sensory neurological complications. No motor neurological complications occurred. CONCLUSION: Prolonged duration of PCNL and increased value of hemoglobin drop may lead to increased risk of neuropathy. Larger prospective studies with retroperitoneal imagings and patients' follow up is suggested for better understanding of this complication.

Laparoscopic transperitoneal ureterolithotomy: a single-center experience.

INTRODUCTION: This study aimed to evaluate success and complications of laparoscopic transperitoneal ureterolithotomy at our center. PATIENTS AND METHODS: From November 2008 until September 2011, 33 patients, including 22 men and 11 women, with a mean age of 45.3 years (range, 19-67 years), underwent laparoscopic ureterolithotomy at our center. Locations of stones were the upper, middle, and lower ureter in 29, 1, and 3 patients, respectively. Ten patients had a history of previous abdominal or pelvic surgery. Laparoscopic ureterolithotomy was performed via a transperitoneal approach. Complications and outcomes were evaluated. RESULTS: Mean operation time was 85.48±15.11 minutes. Except for one stone migration and one conversion to open surgery, all the ureteral stones were extracted laparoscopically (94% success rate). A double J stent was inserted antegradely during the procedure and remained for about 1 month in all cases except in 1 patient in whom both antegrade insertion and ureteroscopic relocation were used. Postoperative hypercapnia was detected in a young patient, who recovered with conservative treatment. No visceral complication occurred. The mean hospital stay and the drain installation interval were 4.1 days (range, 3-9 days). The mean return to full activity was 11.91±4.65 days. Preoperative hydronephrosis resolved at follow-up ultrasonography (3 months later) in all patients except 2 cases, in whom intravenous pyelography showed no obstruction (memorial hydronephrosis). CONCLUSIONS: Laparoscopic transperitoneal ureterolithotomy is a safe and effective treatment modality for skilled surgeons and a convenient option for patients. Challenges, such as lower ureteral stones, redo cases, and antegrade double J stent insertion, can be overcome by experience.

Clipless laparoscopic retroperitoneal lymph node dissection using bipolar electrocoagulation for sealing lymphatic vessels: initial series.

PURPOSE: To evaluate the outcome of laparoscopic retroperitoneal lymph node dissection (LRPLND) using bipolar electrocoagulation instead of clipping the lymphatic vessels. MATERIALS AND METHODS: Between August 2002 and April 2008, a total of 13 patients underwent transperitoneal LPRLND for nonseminomatous germ cell tumor of the testis. In this experience, in contrast to other techniques, we did not use clips for ligation of the lymphatic vessels; instead, we used bipolar cautery for coagulation of the lymphatic vessels. We followed up the patients for lymphocele formation or lymphatic leakage using abdominal computed tomography scan. RESULTS: Mean age of the patients was 24.2 years (range, 19 to 39 years). Six tumors were on the left side and 7 on the right. Pathological stage was I in 12 patients and IIA in one. The mean follow-up period was 29.9 months (range, 3 to 70 months). No re-operation was required. There was no prolonged lymphatic leakage or lymphocele formation during the follow-up period. CONCLUSION: Our study demonstrates that using bipolar electrocoagulation instead of clips, for sealing of the lymphatic vessels during LRPLND, does not hamper the outcome of the procedure. This should be further evaluated in randomized clinical trials with more subjects.

Kidney displacement in complete supine PCNL is lower than prone PCNL.

To compare the amount of the kidney displacement in the complete supine percutaneous nephrolithotripsy (PCNL) to the prone PCNL during getting renal access. Thirty-three patients were randomly divided into two groups. The patients in group A were placed in the complete supine position and the patients in group B in the prone position. Amounts of the kidney displacement in three states and other data were analyzed. The mean amount of the kidney displacement in the complete supine PCNL was 10.1 ± 7.9 mm in stage 1, 10.7 ± 8.28 mm in stage 2 and 12.2 ± 10.4 mm in stage 3. The mean amount of the kidney displacement in prone PCNL was 16.6 ± 5.8 mm in stage 1, 16.2 ± 6.3 mm in stage 2 and 17.6 ± 6.7 mm in stage 3. In stages 1 and 2, a significant difference between the two groups derived from the mean amount of the kidney displacement, but the difference was not statistically significant in stage 3. Adjusted for age, gender, BMI, stone burden and position of PCNL, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors, only BMI had a significant effect on the amount of the kidney displacement (in stages 2 and 3). Performing PCNL in the complete supine position is safe and effective and leads to less kidney displacement during getting renal access and therefore, it may be considered in most patients requiring PCNL.

X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance.

PURPOSE: Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. METHODS: Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. RESULTS: The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. CONCLUSIONS: Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.

Totally ultrasonography-guided percutaneous nephrolithotomy in the flank position.

PURPOSE: To present totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) in the flank position, its preliminary results, and the practical considerations. PATIENTS AND METHODS: From January 2007 until July 2007, a total of 30 candidates for PCNL (22 men and 8 women), with a mean age of 40.69 +/- 13.9 years (range 18-65 yrs), were included in this study. We eliminated radiography, and both access to the collecting system and tract dilation were performed under ultrasonographic guidance. The patients were placed in the standard flank position. RESULTS: Twenty-five (83.3%) patients had complete stone clearance. The stone-free rate was 88.9% in the patients with a single calculus (18 cases), and it was 75.0% in the patients with staghorn or multiple calculi (12 cases). There was no major complication intraoperatively or postoperatively. The mean operative time was 68.75 +/- 34.48 minutes (range 30-150 min). The mean hospitalization time was 3.8 +/- 1.15 days (range 3-7 d). CONCLUSION: Totally ultrasonography-guided PCNL has satisfactory outcomes compared with the standard technique of PCNL, without any major complications and with the advantage of preventing radiation hazards and damage to the adjacent organs. Furthermore, using this technique, anesthesia is more tolerable in the flank position.

Comparison of urinary proteins in calcium stone formers and healthy individuals: a case-control study.

OBJECTIVE: This study aimed at comparing the urinary protein levels in calcium stone formers with those of healthy individuals. PATIENTS AND METHODS: From January 2002 until June 2004, 100 calcium stone formers (mean age 38.6 +/- 10.3 years), who had at least two episodes of calcium stone formation, were compared with 100 healthy individuals (mean age 33.8 +/- 9.7 years). Their 24-hour urinary protein levels, using SDS-PAGE, were measured. RESULTS: The mean 24-hour urinary Tamm-Horsfall protein (THP) levels were 3.3 +/- 0.8 mg in the case group and 4.6 +/- 1.9 mg in the controls, and the difference was not statistically significant (p = 0.53). However, the THP levels in individuals with and without bacteriuria were significantly different (15.8 +/- 3.3 mg vs. 2.6 +/- 1.0 mg, p = 0.0001). The mean 24-hour urinary albumin concentrations were 163.31 +/- 15.1 mg in the case group and 74.26 +/- 4.6 mg in the controls. The mean 24-hour urinary transferrin levels were 8.09 +/- 2.7 mg in the case group and 0.40 +/- 0.3 mg in the controls. The differences were statistically significant for both albumin and transferrin (p < 0.0001 and p = 0.0063, respectively). There were no significant differences in any other mean urinary protein concentrations between cases and controls. CONCLUSIONS: The THP level in the urine of stone formers is not quantitatively different from that of healthy individuals, but it increases in association with bacteriuria. Albumin and transferrin may play a presumptive role in stone formation.

Urinary Tamm-Horsfall protein and citrate: a case-control study of inhibitors and promoters of calcium stone formation.

INTRODUCTION: This study aimed to compare urinary Tamm-Horsfall protein (THP), citrate, and other inhibitors and promoters of stone formation in calcium stone formers with those in healthy individuals. MATERIALS AND METHODS: From January 2002 to June 2004, 100 calcium stone formers (mean age, 38.6 +/- 10.3 years) who had at least 2 episodes of calcium stone formation were compared with 100 healthy individuals (mean age, 33.8 +/- 9.7 years). Their 24-hour urine THP (using the sodium dodecyl sulfate polyacrylamide gel electrophoresis method), citrate, calcium, uric acid, oxalate, and magnesium values were measured and compared. RESULTS: The mean 24-hour urine THP was 3.3 +/- 8.1 mg in patients in the study group and 4.6 +/- 19.2 mg in controls (P = 0.5). However, THP in individuals with and without bacteriuria was significantly different (15.8 +/- 33.6 versus 2.6 +/- 10.2, P < 0.001). Mean 24-hour urinary calcium, citrate, and oxalate values were 232.6 +/- 95.3 mg and 177.8 +/- 82.7 mg (P < 0.001), 132 +/- 103.2 mg and 395 +/- 258.5 mg (P < 0.001), and 18.9 +/- 22.5 mg and 10.4 +/- 8.5 mg (P < 0.001) in patients in the study and control groups, respectively. There was a significant positive correlation between urinary citrate and promoters of stone formation, including urinary calcium, oxalate, and uric acid, in patients in the control group, but not in patients in the study group. CONCLUSION: THP in the urine of stone formers is not quantitatively different from that of healthy individuals, but it is different in patients with bacteriuria. Increased urinary excretion of calcium, oxalate, and uric acid in stone formers with no increase in urine citrate may play a role in the pathogenesis of recurrent stone formation.

The relationship between lipid profile and erectile dysfunction.

PURPOSE: To evaluate the relationship between serum lipids including cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride and erectile dysfunction (ED). MATERIALS AND METHODS: From January 2000 to June 2003, 100 patients with organic ED, who were referred to our center, were selected and their lipid profile (Cholesterol, Triglyceride, HDL, LDL) were assessed. The results were compared with those in 100 healthy individuals. RESULTS: Mean age of men in the study and control groups were 43.72 +/- 9.76 and 43.59 +/- 10.51 years, respectively. Mean plasma cholesterol and LDL levels in individuals suffering from erectile dysfunction were significantly higher than controls (P = 0.04 and P = 0.02, respectively). However, no difference in the mean plasma triglyceride and HDL levels was seen. Odds Ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97, respectively (r2 = 0.04 and r2 = 0.04). Using linear regression analysis, the regression coefficient for cholesterol and LDL versus the International Index of Erectile Dysfunction Questionnaire (IIEF) score were -0.036 and -0.035, respectively (95% confidence interval: 0.98 - 2.5 for cholesterol and 1.13 - 2.81 for LDL). CONCLUSION: The impact of total cholesterol and particularly LDL on men's erectile function underlines the role of hyperlipidemia treatment in prevention of ED and emerges a holistic management in ED patients.