Correction to: Demineralized bone matrix and hydroxyapatite/tri-calcium phosphate mixture for bone healing in rats.

The first name of one author is missing in the published article. The correct abbreviation: H.C. Gemalmaz.

Enuresis: point prevalence and associated factors among Turkish children.

The aim of this study was to establish the prevalence and associated factors of enuresis nocturna and to better understand nocturnal bladder control in Turkish children. A randomized epidemiological study was performed among primary school children, aged four to 12 years, living in Aydin, Turkey. After data collection via a self-administered questionnaire completed by the parents, data of 2,300 children were accepted for the analysis. The overall prevalence of reported marked nocturnal enuresis (at least weekly) was 11.6 percent and of day wetting 0.8 percent. Enuresis was more frequent in boys than in girls. Age, family history of enuresis, large family size, urinary tract infections and low parental socioeconomic class were all statistically associated with reported enuresis nocturna. Familial history among the enuretics and non-enuretics was 40.7 percent and 9.5 percent, respectively. Of the enuretics, 11 percent were treated professionally, 65 percent were treated traditionally by the family and 25 percent sought no help to manage the enuresis. A reference age of 2.9 +/- 1.6 years was calculated for nocturnal bladder control of the children studied. These results suggest that prevalence of enuresis nocturna and development of bladder control in Turkish children are not so different from that seen in other European and Middle East countries, and that the most significant factors associated with enuresis are socioeconomic and familial ones. Turkish families do not have a high level of concern about enuresis, even in the older children. This study demonstrated that enuresis is a sizable problem in Turkey and that a great ignorance about enuresis by both parents and physicians exits.

In vivo and in vitro investigation of the effects of sildenafil on rat cavernous smooth muscle.

PURPOSE: We investigated the effect of sildenafil on rat erectile tissues in vivo and in vitro. MATERIALS AND METHODS: Intracavernous pressure was recorded in pentobarbital anesthetized, male Sprague-Dawley rats and we studied the effect of 100 or 200 microg/kg(-1) sildenafil given intravenously. In an isolated endothelin-1 contracted strip preparation of rat corpus cavernosum we also assessed the effect of sildenafil on the response to electrical field stimulation of the nerves. RESULTS: Electrical stimulation of the cavernous nerve induced a frequency dependent increase in intracavernous pressure of a mean plus or minus standard error of mean 55 +/- 3 mm Hg at 20 Hz, corresponding to a mean of 47% +/- 2% of mean arterial pressure. The 100 microg/kg(-1) dose did not increase intracavernous pressure but significantly increased mean decay time of the pressure response from 16 +/- 3 to 35 +/- 3 seconds (p <0.001). In vitro sildenafil significantly enhanced the amplitude and duration of the relaxation induced by the electrical stimulation of corpus cavernosum strips in a concentration dependent fashion. CONCLUSIONS: In anesthestized rats sildenafil significantly prolonged the decay period of the intracavernous pressure response induced by electrical stimulation of the cavernous nerve but it did not increase the amplitude. Sildenafil enhanced the amplitude and duration of the relaxant response to electrical field stimulation in isolated corpus cavernosum tissue.

Persistently increased voiding frequency despite relief of bladder outlet obstruction.

PURPOSE: Bladder outlet obstruction (BOO) can increase urinary frequency. Even after surgical relief of obstruction, up to 30% of patient are still bothered by irritative voiding symptoms. We tested the hypothesis that deligation of a partial bladder outlet obstruction model mimics this clinical observation. MATERIALS AND METHODS: Female Wistar rats were obstructed for 3 weeks by partial urethral ligation and then were relieved of obstruction by urethral deligation. Measurements of voiding frequency and voided volumes were measured preoperatively, after ligation, and after deligation. Relief of obstruction was confirmed by measuring flow rates through ex vivo perfusion of deligated urethras. Urine osmolality and bladder weights were determined. Awake cystometrograms (CMGs) were performed 3 weeks after deligation to measure bladder function. RESULTS: Neither sham ligation nor sham deligation altered voiding frequency. Ligation doubled mean voiding frequency (in cc) from 2.01 +/- 0.32 to 3.96 +/- 0.22 per 4 hours (p = 0.0002). Three weeks after deligation, voiding behavior of the animals segregated into 2 groups: 20% had persistent hyperactive voiding frequency (6.67 +/- 1.23 per 4 hours) while 80% normalized voiding frequency (1.53 +/- 0.20 per 4 hours). The difference in voiding frequency in these 2 groups could not be attributed to alterations in urine osmolality, persistence of urethral obstruction, difference in bladder weights or severity of initial obstruction created. Awake CMGs revealed a higher peak micturition pressure and lower voided volume in the hyperactive voiders. CONCLUSIONS: 20% of the animals after urethral deligation had persistent hyperactive voiding which parallels clinical observations. Because the CMG data suggested persistent obstruction, yet urethral perfusion and bladder weights indicated no obstruction, we propose that these 20% of animals have a "functional" bladder outlet obstruction and can be used to study mechanisms underlying hyperactive voiding.

The effect of sildenafil on apomorphine-evoked increases in intracavernous pressure in the awake rat.

PURPOSE: The aim of this study was to develop a quantitative, awake animal model to investigate the effect of sildenafil on centrally-evoked erectile activity. METHODS: Intracavernous pressures were recorded in awake, male Sprague Dawley rats after administration of apomorphine (100 or 250 microg./kg. subcutaneously). Sildenafil (100 microg./kg. intravenously) was then given 10 min. after a second dose of apomorphine. The time to first response, duration of response, and peak intracavernous pressure and area under the response, were measured before and after sildenafil. RESULTS: Apomorphine produced rhythmic increases in intracavernous pressure. The pressure increase consisted of two components. The amplitude of the first, tonic response was 58 +/- 3 mm. Hg, and a superimposed, burst-like increase in pressure elevated this further to 81 +/- 6 mm. Hg. Bilateral transection of the pudendal nerves abolished the burstlike pressure changes; bilateral transection of the cavernous nerves prevented both responses. The duration of the apomorphine-induced increase in intracavernous pressure was significantly (p = 0.003) prolonged by sildenafil (100 microg./kg.) from 37 +/- 4 to 62 +/- 11 s (n = 6). The overall intracavernous pressure response to apomorphine (100 microg./kg.), measured as the area under the curve, was significantly (p = 0.003) increased by sildenafil (100 microg./kg.) from 67 +/- 8 to 142 +/- 31 units (n = 6). N-nitro-L-arginine methyl ester (40 mg./kg. intravenously) prevented the apomorphine-induced responses. CONCLUSIONS: Monitoring intracavernous pressures in the awake rat represents a simple model to evaluate the effect of drugs on erectile function. Using this model we have shown that apomorphine elicits a rise in intracavernous pressure that can be prolonged by sildenafil. These results suggest that there may be a role for the combination of apomorphine and sildenafil in the management of erectile dysfunction.

Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels.

OBJECTIVE: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. PATIENTS AND METHODS: Totally 57 patients with histologically proven BPH (age range 54-81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. RESULTS: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks' evaluation (p < 0.001) no significant difference could be shown during the 3 months' examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks' follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). CONCLUSIONS: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.

Reconstruction of ureteral defects with a tubular skin graft secondarily prefabricated utilizing omentum as a carrier: an experimental study.

OBJECTIVES: This study was conducted to evaluate reconstruction of the ureter in dogs after resection of a 7-cm-long midlength segment with a vascularized tubular skin graft secondarily prefabricated utilizing omentum as a carrier. METHODS: Nine female mongrel dogs underwent surgery in which omental surface capabilities were used to create a vascularized prefabricated skin graft. After 4 weeks, all 9 dogs underwent the second surgical procedure, which included the resection of a 7-cm-long segment from the ureter and an interureteral anastomosis of the omentocutaneous cylindrical tube. At postoperative week 10, just before the third surgical procedure, intravenous urography was performed to evaluate the continuity of the treated ureter. Nephroureterectomy was also performed immediately after intravenous urography to obtain specimens for histologic analysis of the aforementioned tubular anastomosis. RESULTS: The continuity of the ureteral defect was restored with the help of the omentocutaneous cylindrical tube. There was no narrowing throughout the ureter and along the omentocutaneous cylindrical tube. Only minimal dilation occurred at the neoskin tube and at the ipsilateral collecting system. Histopathologically, there were capillary protrusions entering the skin graft from the omental vasculature. The columnar epithelium of the cutaneous cylindrical tube was completely preserved, and transitional ingrowth was present at the proximal and distal ends of the tube. CONCLUSIONS: The surgical procedure resulted in successful reconstruction of ureteral continuity by the use of a prefabricated omentocutaneous cylindrical tube in dogs.