Extracorporeal magnetic innervation for the treatment of stress urinary incontinence: results of two-year follow-up.

INTRODUCTION: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. RESULTS: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 +/- 10.7 to 6.5 +/- 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. CONCLUSION: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

Sildenafil citrate as a phosphodiesterase inhibitor has an antioxidant effect in the blood of men.

BACKGROUND AND OBJECTIVE: Sildenafil citrate enhances the action of nitric oxide by preventing the hydrolysis of cGMP, and is widely used to treat erectile dysfunction. We investigated the effects of sildenafil citrate administration on lipid peroxidation and antioxidant redox enzymes in blood of healthy men. METHOD: Thirty healthy male subjects were divided equally into two groups. The first group was used as the control. A single dose of sildenafil citrate was administrated orally to subjects constituting the second group. Blood samples were obtained at 0, 2, 6 and 24 h after intake of the single dose of 100 mg sildenafil citrate or placebo. RESULTS AND DISCUSSION: The dose of sildenafil citrate resulted in significant increase in the erythrocyte superoxide dismutase and catalase activities at 6 and 24 h. Plasma lipid peroxidation levels decreased slightly. There was no statistical difference in erythrocyte glutathione peroxidase activity between the placebo and sildenafil citrate groups. CONCLUSION: Treatment of blood with 100 mg sildenafil citrate has protective effects on oxidative stress by inhibiting free radical formation and by supporting antioxidant redox systems.

Leptin expression in the testicular tissue of fertile and infertile men.

There have been several studies about the presence of leptin in serum and testicular tissue, and none of them compares the leptin expression in the testicular tissue of fertile and infertile men. We assessed the presence of leptin expression in the testicular tissue of fertile and infertile men. 20 azoospermic infertile men were included in the study. All patients underwent testicular sperm extraction (TESE) for ICSI. For the detection of leptin, the immunohistochemistry was carried out. Intensity of immunohistochemical staining was subjectively estimated and expressed as negative (-), weak positive (+), intermediate positive (++) and strong positive (+++). Testicular tissues of 5 fertile patients, aged 50-60 years, was stained with leptin for control group. Mann-Whitney U test was used as the statistical method. There was no statistically significant difference in leptin staining between infertile patients and control group (p < 0.05). Leptin staining in tubuli seminiferi and Leydig cells were generally equal or Leydig cells were stained (+) much. This difference was not statistically significant. We found that there is leptin staining in Leydig cells and tubuli seminiferi. There is no difference in normal and infertile men for leptin staining properties in testicular tissue. This condition suggests that the effect of leptin on reproductive functions originates from a systemic effect related to central neuroendocrine system, androgen levels or spermatogenic existence rather than its direct effect on testicular tissue.

Detection of vesico-ureteric reflux in children by colour-flow Doppler ultrasonography.

OBJECTIVES: To assess the findings of colour-flow Doppler ultrasonography (DUS) in the diagnosis of vesico-ureteric reflux (VUR), as an alternative to the primary diagnostic tool, voiding cysto-urethrography (VCUG). PATIENTS AND METHODS: Thirty-five children (aged 2-15 years) were examined for VUR by DUS and standard VCUG. All patients underwent DUS and VCUG within 48 h but the findings of the latter were not reported to the ultrasonographer. The DUS was undertaken using a colour Doppler real-time system; a positive ultrasonogram was defined by visualizing Doppler signals from the bladder to the ureter during the course of bladder filling. RESULTS: Of the 70 ureters assessed, 28 were refluxing on DUS and 29 on VCUG; there were two false-positive and three false-negative results. Comparing the two methods showed DUS to be 90% sensitive with a specificity of 93% for detecting VUR. Four patients underwent reimplantation during their treatment. DUS findings correlated well with standard VCUG in these patient as a method of follow-up. CONCLUSION: DUS can be used as an alternative to standard VCUG for screening and following VUR. In addition, DUS avoids the danger of exposure to ionizing radiation and the unpleasant catheterization that many of these children fear.

Megacystis secondary to myenteric plexus pathology. Presentation of two cases.

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.

Acupuncture therapy in the management of persistent primary nocturnal enuresis--preliminary results.

OBJECTIVE: This study aimed to assess the comparative therapeutic efficacy of traditional Chinese acupuncture. MATERIAL AND METHODS: During the period from January 1997 to April 1999, 50 children (23 boys, 17 girls) suffering from primary persistent nocturnal enuresis, aged 9-18 years, were included in the study. The response rate was monitored at 2 and 4 weeks, and then every 3 months by recording dry nights on a calendar. RESULTS: The efficacy of treatment, which was expressed as a percentage of dry nights, was high. Within 6 months, 43 (86%) patients were completely dry and 2 (10%) patients were dry on at least 80% of nights. CONCLUSIONS: Treatment using acupuncture in patients with persistent enuresis nocturna appeared to be most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results, even after the end of the study.

Comparative early results of the sandwich technique and transurethral electroresection in benign prostatic hyperplasia.

No study has yet reported the comparative results of the sandwich technique and transurethral electroresection in the management of benign prostatic hyperplasia. Thirty patients with benign prostatic hyperplasia were divided into two groups, each consisting of 15 patients. The first group underwent the sandwich technique (transurethral electrovaporization-transurethral electroresection-transurethral electrovaporization) and the second group had transurethral electroresection alone (TURP). Preoperatively all patients underwent a digital examination and the determination of prostatic volume by transrectal ultrasonography, and a symptom score (IPSS), the maximal flow rate (Q (max)), post-void residual urine (PVR). Six months after the operation, all the variables were remeasured and the values compared with those before treatment and between the groups. The improvements in symptom score, residual urine and maximum flow rate were slightly better after the sandwich technique than after TURP but the differences between the two groups were not statistically significant. Additionally, lower amounts of irrigant solution were used (P>0.05) and operative time was shorter in the sandwich group (P>0.05). Although the duration of catheterization in the sandwich group was lower than that of the TURP group (1.6 and 2.26 days respectively (P<0.05)), three patients (20%) required catheterization. Although the improvements in the objective parameters 6 months after, early indications showed that the sandwich technique results were almost the same as after TURP. There might be several advantages of this technique, particularly the fact that no blood transfusion is required and earlier removal of urethral catheter.Prostate Cancer and Prostatic Diesases (2001) 4, 242-244.

Prostatic fluid-free insulin-like growth factor-1 in relation to prostate cancer.

OBJECTIVES: To establish the feasibility of measuring free insulin-like growth factor-1 (IGF-1) in prostatic fluid and to determine if there is a difference in free IGF-1 levels in the prostatic fluid of patients with prostatic adenocarcinoma and in normal men. PATIENTS AND METHODS: Prostatic fluid samples were collected from men with histologically confirmed prostate cancer and from control subjects with no malignancy. Prostatic fluid and serum free IGF-1 levels were measured in duplicate by radioimmunoassay, and the differences analysed using the Mann-Whitney U-test and Pearson correlation. RESULTS: Prostatic fluid free IGF-1 concentrations did not differ significantly (P = 0.23) and there was no difference in serum free IGF-1 levels between the groups. While serum PSA level was significantly correlated with age (P < 0.001) the free IGF-1 level of prostatic fluid was not. There was also no correlation between prostatic fluid free IGF-1 and serum PSA levels. CONCLUSIONS: Free IGF-1 can be detected in prostatic fluid with acceptable sensitivity. However, the free IGF-1 level in prostatic fluid does not help to detect patients with prostate cancer and is not a tumour marker.

Adenosine deaminase, 5'nucleotidase, xanthine oxidase, superoxide dismutase, and catalase activities in cancerous and noncancerous human bladder tissues.

Activities of adenosine deaminase (ADA), 5'nucleotidase (5NT), xanthine oxidase (XO), superoxide dismutase (SOD), and catalase (CAT) enzymes were measured in cancerous and cancer-free adjacent bladder tissues from 36 patients with bladder cancer and in control bladder tissues from 9 noncancer patients. Increased ADA and decreased XO, SOD, and CAT activities were found in cancerous bladder tissues compared with those of cancer-free adjacent tissues and of control bladder tissues. Differences were also found between enzyme activities in the bladder of different disease stages and grades. In the cancerous tissues, only positive intracorrelations were found, but in the cancer-free adjacent tissues and control tissues, both positive and negative correlations were established between enzyme activities. Results suggested that purine metabolism and salvage pathway activity of purine nucleotides were accelerated in the cancerous human bladder tissues via increased ADA and decreased XO activities, probably together with changes in some other related enzyme activities and, free radical metabolising-enzyme activities were depressed in cancerous bladder tissues, which indicated exposure of cancerous tissues to more radicalic stress.

Iron, copper, cadmium, zinc and magnesium contents of urinary tract stones and hair from men with stone disease.

Forty-seven urinary tract stones consisting of 5 pure magnesium ammonium phosphate (subgroup 1), 5 mixed calcium oxalate-magnesium ammonium phosphate (subgroup 2), 8 mixed calcium oxalate-calcium phosphate (subgroup 3), 6 mixed calcium oxalate-uric acid (subgroup 4) and 23 pure calcium oxalate stones (subgroup 5) and hair from these patients and control subjects were analyzed for iron, copper, cadmium, zinc and magnesium content by atomic absorption spectroscopy. Mean values +/- SD for each group were determined and statistical correlations were made to establish differences among the stone elements themselves, the hair elements themselves, and the stone and hair elements for group 5 (calcium oxalate stone group). We found significant differences among the element levels of the stones, patient hair and control hair. In particular, hair magnesium and cadmium levels of control and patient groups appear to have promising features for future work concerning urinary tract stone disease.