Endourological treatment of foreign bodies in the urinary system.

BACKGROUND AND OBJECTIVES: In this retrospective study, nature, clinical presentations, diagnostic modalities, and endoscopic treatment of urinary system foreign bodies were evaluated. METHODS: A total of 8 cases were treated with endoscopic surgery between February 15, 2007 and June 12, 2012. Clinical findings, radiologic diagnosis, and management were reviewed. RESULTS: We observed that urinary tract foreign bodies were generally secondary to iatrogenic causes; however, bladder/urethral foreign bodies could also be due to self-insertion. Clinical findings were different secondary to their location in the urinary system. All foreign bodies were treated endoscopically. CONCLUSIONS: Foreign bodies of the urinary system can successfully be treated with endoscopic modalities without any complications.

Effectiveness of Flexible Ureterorenoscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones Smaller Than 2 cm.

Purpose. To evaluate the safety and efficacy of RIRS for the treatment of multiple unilateral intrarenal stones smaller than 20 mm. Methods. Between March 2007 and April 2013, patients with multiple intrarenal stones smaller than 20 mm were treated with RIRS and evaluated retrospectively. Each patient was evaluated for stone number, stone burden (cumulative stone length), operative time, SFRs, and complications. Results. 173 intrarenal stones in 48 patients were included. Mean age, mean number of stones per patient, mean stone burden, and mean operative time were 40.2 ± 10.9 years (23-63), 3.6 ± 3.0 (2-18), 22.2 ± 8.4 mm (12-45), and 60.3 ± 22.0 minutes (30-130), respectively. The overall SFR was 91.7%. SFRs for patients with a stone burden less and greater than 20 mm were 100% (23/23) and 84% (21/25), respectively (χ (2) = 26.022, P < 0.001). Complications occurred in six (12.5%-6/48) patients, including urinary tract infection or high-grade fever >38.5°C in three cases, prolonged hematuria in two cases, and ureteral perforation in one case, all of whom were treated conservatively. No major complications occurred. Conclusions. RIRS is an effective treatment option in patients with multiple unilateral intrarenal stones especially when the total stone burden is less than 20 mm.

Serum homocysteine levels and sildenafil 50 mg response in young-adult male patients without vascular risk factors.

The aim of the present study was to investigate serum homocysteine levels in patients with erectile dysfunction and to evaluate the relationship between serum homocysteine levels and response to the standard 50 mg phosphodiesterase 5 inhibitor treatment. Twenty-eight erectile dysfunction patients having normal vascular parameter according to Penile Doppler Ultrasonography and twenty healthy subjects were enrolled in the study. All subjects filled The International Index of Erectile Function (IIEF) questionnaire. A total of 4-6 doses of phosphodiesterase 5 inhibitor (sildenafil 50 mg) were given to patients. Later, they were divided into two groups as sildenafil responder and non-responder. Serum homocysteine levels were compared in groups based on sildenafil response. Compared with healthy subject, higher homocysteine levels were observed in patients with erectile dysfunction (p = 0.005), especially in sildenafil non-responder group (p = 0.005). There was significant negative correlation between homocysteine and IIEF scores in group responder to sildenafil treatment (r = -0.698, p = 0.008). Mean IIEF scores of patients with non-responder to sildenafil 50 mg were lower than those of controls (p = 0.0001), but mean IIEF scores of patients with responders approached values observed in control subjects (p = 0.002). The results indicated that measurement of serum homocysteine levels could be used as a marker for the evaluation of efficacy of phosphodiesterase 5 inhibitor and the selection of efficacious alternative therapies.

The difference of heart rate recovery between males with and without erectile dysfunction.

AIM: In this study, we aimed to investigate the relationship between heart rate recovery (HRR) time and Chronotropic Index (CHIND) parameters, which also reflect autonomic function, after exercise stress test (EST) in males with or without erectile dysfunction (ED), and we investigated the relationship between HRR and CHIND and serum steroid hormone levels. MATERIAL AND METHODS: A total of 135 participants (mean age: 45.0 +/- 11.8 years) were enrolled into the study. Detailed biochemical and hormonal analyses, 12-lead electrocardiography and EST (Treadmill) were performed in all participants. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire form. Patients were categorized into two groups according to their IIEF scores as ED (+) (IIEF < 26) and ED (-) (IIEF > or = 26). Afterward, statistical analyses were performed to evaluate the correlations between ED and HRR and CHIND. RESULTS: A total of 65 patients were ED (+) (mean age 44.9 +/- 6.4 years), while 70 patients (mean age 43.7 +/- 7.7 years) had normal erectile status. There were statistically significant differences in CHIND (P = 0.015) and HRR time (P = 0.037) between ED (+) and ED (-) patients. In correlation analysis, IIEF score was found positively correlated with HRR and metabolic equivalent (MET) values (r(HRR)= 0.293, P = 0.037; r(METs)= 0.388, P = 0.011, respectively). Linear regression analysis revealed that METs value and total exercise time had a more linear relationship with IIEF score compared to the other EST parameters (p(METs)= 0.002 and p(TET)= 0.015, respectively). CONCLUSION: Chronotropic incompetence and dynamic postexercise autonomic dysfunction are present in ED patients. This condition may reflect decreased functional capacity and exercise intolerance in these patients.

Comparison of the differences in circadian autonomic function in hyperlipidemic men with and without erectile dysfunction.

BACKGROUND: We aimed to investigate differences in circadian autonomic changes in patients suffering from hyperlipidemia with and without erectile dysfunction and compared results to control cases. MATERIALS AND METHODS: A total of 77 patients (age range: 24-74, mean age: 45.3 ± 9.3) with uncontrolled hyperlipidemia (total cholesterol >200 mg/dL and/or LDL >160 mg/dL despite a regular diet) were enrolled into the study. These patients were divided into two groups according to their International Index of Erectile Function (IIEF-EF) scores as having erectile dysfunction (IIEF-EF < 26) (Group 1) or as having normal erectile function (IIEF-EF ≥ 26) (Group 2). In addition, the control group comprised 44 healthy men (age range: 20-57, mean age: 44.0 ± 10.8) (Group 3). Heart rate variability parameters obtained by 24-h Holter monitoring were utilized for the indirect evaluation of autonomic function. RESULTS: There were statistically significant differences between the groups with respect to daytime and nocturnal autonomic activity (p < 0.005). Moreover, Group 1 had lower nocturnal parasympathetic and higher nocturnal sympathetic activity compared to the other groups (for nocturnal HFn p(1-2) < 0.001; p(1-3) < 0.001; p(2-3) > 0.05; for nocturnal LFn p(1-2) < 0.001; p(1-3) < 0.001; p(2-3) > 0.05). CONCLUSION: We concluded that hyperlipidemia results in deterioration of autonomic circadian rhythm. Hyperlipidemic patients with erectile dysfunction had diminished nocturnal parasympathetic activities.

The effect of varicocele on seminal plasma and serum inhibin-B levels in adolescent and adult men.

INTRODUCTION: In the present study, the relationship between serum/seminal plasma and serum FSH and seminal parameters was evaluated in adults and adolescent varicocele patients and compared with normal fertile cases. METHODS: A total of 50 adult patients with varicocele (Group-1) and 50 adolescents with varicocele (Group-2) were enrolled into the study. Fifty fertile cases without any scrotal pathology were accepted as control group (Group-3). Serum gonadotropin, sex steroids and serum and seminal plasma inhibin-B levels were measured, and semen analysis was performed after 2 and 5 days of sexual abstinence. All parameters were compared among three groups by using one-way ANOVA test. RESULTS: There were statistically significant differences among three groups on seminal parameters due to disturbed spermatogenesis in patients with varicocele (P < 0.05). However, there were not statistical differences between serum and seminal plasma Inhibin-B levels among groups. In varicocele patients, serum inhibin-B levels showed negative and significant correlation only with FSH levels (r = -0.253, P = 0.011). On the contrary, neither serum nor seminal plasma inhibin-B levels showed significant correlation with seminal parameters. CONCLUSION: While varicocele affects different mechanisms in the regulation of spermatogenesis in testes, serum and seminal plasma inhibin-B have not any role in decreased spermatogenesis in varicocele.

The relationship between serum sex steroid levels and heart rate variability parameters in males and the effect of age.

OBJECTIVES: We evaluated the relationships between sex steroid levels and heart rate variability (HRV) parameters. STUDY DESIGN: The study included 114 male subjects (mean age 46.6±11.3 years) presenting to our department for cardiologic evaluation. Hormonal analysis included serum levels of luteinizing hormone, prolactin, total testosterone (TT), free testosterone, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S). Parameters of HRV were derived from 24-hour Holter monitoring. The associations between serum sex steroid levels and HRV parameters were investigated in three age groups (20-39 years; 40-59 years; >60 years). RESULTS: All the participants had normal biochemical results. The three age groups were similar in terms of anthropometric measurements. Among sex steroids analyzed, only serum DHEA-S level was significantly different among the groups (p=0.026), showing a decreasing trend with age. In the evaluation of HRV, all parasympathetic activities decreased (for HFn, pNN50, and rMSDD: p=0.001, p=0.000, and p=0.000, respectively), while only LF/HF among sympathetic activities increased (p=0.000) with age. Partial correlation analysis with control of age and waist circumference showed that TT and DHEA-S were positively correlated with HFn (parasympathetic parameter), and were in negative correlation with LF/HF24 hours and global sympathetic index (GSI) (sympathetic parameters). Serum E2 level was negatively correlated with the parasympathetic parameter of rMSSD, and positively correlated with LF/HF24 hours and GSI. Among serum sex steroids, DHEA-S was the most correlated parameter with autonomic functions. CONCLUSION: Our results showed positive correlations between androgens and parasympathetic activity and between estradiol and sympathetic activity in men, independent from anthropometric factors.

Hereditary haemochromatosis gene (HFE) H63D mutation shows an association with abnormal sperm motility.

The aim of this study was to screen infertile men for HFE H63D mutation in correlation with clinical characteristics of infertile men (sperm concentration, sperm motility, morphology, testicular volume, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and total Testosterone levels) and find out if the HFE H63D mutation has an effect on male infertility. After excluding hormonal treatment, any scrotal pathology, having any systemic diseases such as diabetes mellitus, sickle cell anemia and microdeletions of the Y chromosome, a total of 148 infertile men with age range between 17 and 52-years-old (average age 29.6 +/- 7.2) were enrolled into the study. Our analysis indicates that the mean FSH levels are significantly higher (6.3 +/- 4.6 mIU/ml, P = 0.03), whereas sperm motility is significantly lower (36.6 +/- 28.1%, P = 0.01) in the infertile men with the HFE H63D mutation compared with subjects lacking this mutation. Comparison of allele frequencies of the infertile men with Ts < 50% versus the infertile men with Ts > 50% revealed a significant difference as expected (P = 0.001, OR = 0.14, %95 CI = 0.04-0.44). Comparison of allele frequencies of infertile men with abnormal sperm motility versus infertile men with normal sperm motility revealed a highly significant difference (P = 0.005, OR = 3.11, %95 CI = 1.41-6.86). Thus, the HFE H63D mutation seems to be an important risk factor for impaired sperm motility and is clinically associated with male infertility.

The effect of Behçet's disease on sexual function and psychiatric status of premenopausal women.

INTRODUCTION: Little is known about the relationship between Behçet's disease (BD) and female sexual dysfunction (FSD). AIMS: The aims were to evaluate the prevalence of FSD in premenopausal BD patients and to compare hormonal and psychiatric conditions to healthy subjects. METHODS: A total of 71 married women with BD and 63 healthy married women between 18 and 44 years old were enrolled into the study. After evaluating detailed history and physical examination, serum steroid hormone levels were measured. Presence of genital ulcerations in physical examination and any medical treatment were recorded in patients. All subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and Beck Depression Inventory (BDI) for psychiatric assessment. MAIN OUTCOMES MEASURES: FSFI and BDI scores and serum sex steroid hormone levels were measured in women with BD and healthy controls. RESULTS: The mean BDI score of patients was significantly greater than that for controls (P = 0.001), and there was a statistically significant difference between BDI scores (Pearson chi2 = 19.109, P = 0.001). FSD was found in 34 patients with BD (47.9%) and in 11 controls (17.5%). A statistically significant difference was found between the two groups (Pearson chi2 = 13.855, P = 0.001). While the most common sexual problem in the patients with BD was diminished arousal (n = 49, 69.0%), diminished desire was found in 32 patients (45.1%) and lubrication problems in 36 patients (50.7%). There was a statistically significant negative correlation between BDI and FSFI score in BD patients. On the contrary, there was no relationship between FSFI and presence of genital ulcerations. CONCLUSION: FSD is more common in BD patients than in healthy subjects. We conclude that depressive mood according to the BDI scale correlates with the sexual status of BD patients, and this may be because of the depressive effect of BD as a chronic disease.

Significance of p57(Kip2) down-regulation in oncogenesis of bladder carcinoma: an immunohistochemical study.

AIMS AND BACKGROUND: Cyclin-dependent kinase inhibitors have important roles in the oncogenesis of various tumors including urothelial cancer. The aim of this study was to establish the importance of p57(Kip2), a unique cyclin-dependent kinase inhibitor, in the oncogenesis of bladder carcinoma. This article also focused on another cyclin-dependent kinase inhibitor, p27(Kip1), and telomerase enzyme and examined the relationship between these proteins. MATERIAL AND METHODS: Thirty-one patients with urothelial carcinomas of the bladder and 7 cases with normal urinary bladder mucosa were included in the study. Immunohistochemical study was performed by monoclonal antibodies of p27(Kip1), p57(Kip2), and the telomerase subunit (hTERT). All immunohistochemical preparations were evaluated by an immunohistochemical histological score. RESULTS: p57(Kip2) and p27Kip1) expression were seen in all of the cases of normal mucosa. In carcinoma cases, 8 of 31 (25.8%) showed p57(Kip2) nuclear positivity and 20 of 31 (64.5%) expressed nuclear p27(Kip1). HSCOREs of carcinoma cases showed lower scores of nuclear p57(Kip2) and p27(Kip1) than normal mucosa, but only HSCOREs of nuclear p57(Kip2) (P = 0.001) showed statistical significance. Despite unknown significance, cytoplasmic p57(Kip2) and p27(Kip1) were also evaluated. Immunohistochemical analysis showed that carcinomas expressed higher HSCOREs of hTERT than normal mucosa, and there was a significant difference (P = 0.026) between muscle invasive carcinomas and normal mucosa. CONCLUSIONS: The data showed that p57(Kip2) down-regulation along with p27(Kip1) is a well-established feature of urothelial carcinoma. Probably, this down-regulation of cyclin-dependent kinase inhibitors supports the proliferation phase of oncogenesis. In the study, we also showed that hTERT expression was up-regulated in higher stages of urothelial carcinoma.

Effects of statin treatment on serum sex steroids levels and autonomic and erectile function.

OBJECTIVES: To investigate the effect of statin treatment on serum sex steroid levels, heart rate variability, erectile function, and libido in patients with hyperlipidemia. METHODS: A total of 74 patients (mean age 44.7 +/- 7.1 years) with hyperlipidemia were enrolled into this study. After a cardiac examination, the serum lipid levels were measured, and the 24-hour Holter monitoring, heart rate variability, and autonomic test results were also evaluated. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire. Later, atorvastatin 40 mg/day was initiated in all patients and used for the subsequent 12 months. All diagnostic tests (cardiac, biochemical, and autonomic and the IIEF questionnaire) were performed again at 6 and 12 months of follow-up. RESULTS: A statistically significant decrease was found in the serum lipid levels at 6 months (P <0.05). In contrast, the average IIEF scores (24.7 +/- 6.4 at baseline) had increased to 25.0 +/- 4.9 and 26.1 +/- 5.9 at 6 and 12 months of follow-up, respectively. Although the parasympathetic activities increased and sympathetic activities decreased with atorvastatin treatment, these changes were not statistically significant (P >0.05). In paired comparison, significant differences were found among the IIEF scores of the three periods (P = 0.013). The difference was more evident after 6 months of treatment (IIEF(1vs2) = 0.475; IIEF(1vs3) = 0.027; IIEF(2vs3) = 0.012). CONCLUSIONS: Although improvement in the lipid profile occurred early during the statin treatment, restoration of erectile function appeared later, which could be attributed to the restoration of endothelial functions by lowered serum lipid levels.

Preparation and characterization of infection-resistant antibiotics-releasing hydrogels rods of poly[hydroxyethyl methacrylate-co-(poly(ethylene glycol)-methacrylate]: biomedical application in a novel rabbit penile prosthesis model.

In this work, preparation and characterization of novel three different antibiotic loaded penile prosthesis in the rod form were investigated by copolymerization of 2-hydroxyethylmethacrylate (HEMA) with poly(ethylene glycol)-methacrylate, (PEG-MA). To achieve this goal, a series of novel copolymer hydrogels were prepared in rod form using HEMA and PEG-MA monomers via UV initiated photopolymerization. The thermal stability of the copolymer was found to be lowered by increase in the ratio of PEG-MA in the rod structure. Contact angle measurements on the surface of copolymer hydrogel demonstrated that the copolymer gave rise to a significant hydrophilic surface compared with pure poly(HEMA). The blood protein adsorption and platelet adhesion were significantly reduced on the surface of the copolymer hydrogels compared with control pure poly(HEMA). Poly(HEMA:PEG-MA;1:1)-1 formulation containing different antibiotics (20 mg antibiotic/g polymer) released about 90, 91, and 55% of the total loaded cephtriaxon, vancomycin, and gentamicin in 48 h at pH 7.4, respectively. Finally, antibiotics loaded biocompatible poly(HEMA:PEG-MA;1:1)-1 hydrogel compositions was used as a penile prosthesis in preventing cavernous tissue infections in a rabbit prosthesis model. The efficacy of the three different antibiotics loaded hydrogel system was evaluated in four different groups of rabbits, in which various infectious agents were inoculated. The animals were sacrificed after predetermined time periods, and clinical, histological and microbiological assessment on the implant side were carried out to detect infections. Eventually, we concluded that three different antibiotic loaded penile prostheses (i.e. poly(HEMA:PEG-MA;1:1)-1 hydrogel systems) were as effective as parenteral antibiotics applications.

Diagnosis and management of vaginal mullerian cyst in a virgin patient.

Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 x 20 mm in the vagina. She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with the surrounding structures.

Effects of vardenafil on intraocular pressure and orbital hemodynamics.

PURPOSE: The aim of this study was to investigate the effects of vardenafil on systemic blood pressure, intraocular pressure (IOP), and orbital hemodynamics. METHODS: Twenty-one (21) volunteers suffering erectile dysfunction, with an average age of 51.5 +/- 6.2 years, were enrolled into the study. Brachial blood pressures and IOP were measured, the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the ophthalmic, central retinal, and posterior ciliary arteries were evaluated by color Doppler ultrasonography (CDU) before vardenafil intake. All measurements were repeated after 20 min of vardenafil intake. A paired Student t test was used to evaluate the changes. RESULTS: Systolic blood pressure did not change significantly where diastolic blood pressure decreased significantly (P = 0.043) after drug ingestion. There was no significant change in IOP. Increase in EDV of CRA was significant (P = 0.04), but the increase of orbital blood flow velocities of OA and PCA were insignificant. CONCLUSIONS: The recommended dose of vardenafil has no negative effects on orbital hemodynamics and IOP in patients with erectile dysfunction.

Female sexual and hormonal status in patients with bronchial asthma: relationship with respiratory function tests and psychological and somatic status.

OBJECTIVES: To assess the relationship among the sexual, hormonal, physical, and psychological status of women with bronchial asthma (BA) compared with that of healthy volunteers. METHODS: Thirty-eight women with BA were enrolled in the study. The patients were asked to complete the Female Sexual Function Index, General Health Questionnaire, and Medical Outcomes Study Short Form 36-item Health Survey (SF-36). Using the answers on the SF-36, the mental and physical component summary scores were calculated. A total of 20 healthy women were enrolled in the study as the control group. The same questionnaires were given to this group as well. Statistical analysis was performed using the Mann-Whitney U test and Pearson correlation tests. RESULTS: At the end of the study, statistically significant differences were observed for all questionnaire scores (P <0.05). The most common female sexual dysfunction was diminished arousal (n = 30, 78.9%) in women with BA. In the correlation analysis, the total Female Sexual Function Index score had a statistically significant and positive correlation with the mental component summary score (r = 0.503, P = 0.001) and a negative correlation with the General Health Questionnaire score (r = -0.380, P = 0.020). CONCLUSIONS: The results of our study have shown that BA, as a chronic medical condition, can be a cause of female sexual dysfunction with mental and psychiatric mechanisms.

Is there a relationship among age, international index of erectile function, international prostate symptom score, and aging males' symptoms score?

PURPOSE: To investigate the relationship among the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and Aging Males' Symptoms (AMS) scale scores in various age groups of males. PATIENTS AND METHODS: A total of 307 male patients enrolled in the study. Mean age was 52.3 (range 21-77) years. Group 1 consisted of 51 (< or =39 years), Group 2 consisted of 160 (40-59 years), and Group 3 consisted of 96 (> or =60 years) patients. First five and 15th questions of the IIEF, IPSS, and AMS scale were replied by all the patients. The patients were assessed based on the IIEF for erectile dysfunction (ED), IPSS for lower urinary tract symptoms (LUTS), and AMS scale for Symptomatic Late-Onset Hypogonadism (SLOH). RESULTS: ED, LUTS, and SLOH symptoms were detected in 236 (76.8%), 162 (52.8%), and 184 (59.9%) patients. Except for total AMS scores, IIEF and IPSS scores were significantly different among the groups (p (AMS) = 0.320, p (IIEF) = 0.000, p (IPSS) = 0.000). In the comparisons of the IIEF scores between the each group, significant differences were observed (p (Group1-Group2) = 0.000, p (Group1-Group3) = 0.000, p (Group2-Group3) = 0.000). Nevertheless, IPSS score was significantly lower in the patients with age < or =39 years than the other age groups (p = 0.000). CONCLUSIONS: In the present study, ED ratio and LUTS severity significantly increased in older men. We did not find significant relationship between aging and SLOH symptoms. In the light of our results, LUTS seems to be an important risk factor on erectile function.

Common symptoms in men with prostatic inflammation.

PURPOSE: We evaluated 96 patients with prostatic inflammation in terms of their symptoms and aimed to find common types and frequencies of symptoms in these patients. PATIENTS AND METHODS: The mean age of the patients was 38.0+/-8.7 (range 21-58) years. Physical examination, digital rectal examination, microscopic prostatic secretion assessment and urine cultures after taking a detailed medical history were performed. Urine samples before and after prostatic massage were collected for urine culture. Frequency and types of patients' symptoms were evaluated. All patients were asked about lower urinary tract symptoms, sexual dysfunction and other complaints. RESULTS: Lower urinary tract symptoms and lumbal pain were more prevalent in elder patients. Ejaculation disorder was the most common sexual problem (n=65, 67.7%). Erectile dysfunction and decreased libido were observed in 29 (30.2%) and 22 (22.9%) of the patients. Other complaints were lumbal pain (n=34, 35.4%), perineal fullness (n=50, 52.1%), haemospermia (n=20, 20.8%) and scrotal pain (n=43, 44.8%). CONCLUSION: Prostatic inflammation was usually seen in men of the third and fourth decade. Sexual dysfunction was the most common symptom in this particular group of patients.

Testicular nitric oxide and thiobarbituric acid reactive substances levels in obstructive azoospermia: a possible role in pathophysiology of infertility.

OBJECTIVE: The aim of the study is to evaluate the levels of nitrite/nitrate and thiobarbituric acid reactive substances (TBARS) and their relationship with seminal parameters in experimental obstructive azoospermic rats to explain the possible mechanism of impaired sperm quality in obstructive azoospermia. METHODS: A total of 10 male Spraque-Dawley rats underwent bilateral vas resection and ligation (Group-1 = vasectomy group). The findings were compared with control group (Group-2 = sham group, n = 10). Animals were sacrificed 8 weeks after surgery. Testes were removed and used for the evaluation of nitrate/nitrite and TBARS levels and for histology. Epididymal-aspirated seminal plasma was used for semen count and morphological analysis according to the Kruger criteria. RESULTS: Testicular tissue nitrate/nitrite and TBARS levels were 35.7 +/- 3.1 micromol/g protein and 3.7 +/- 0.1 nmol/g protein in Group-1, and 19.3 +/- 0.7 micromol/g protein and 3.1 +/- 0.1 nmol/g protein in Group-2, respectively. Both parameters showed statistical differences between the two groups. Testicular tissue nitrate/nitrite and TBARS levels showed negative and statistically significant correlations with sperm motility and morphology. CONCLUSIONS: The present study showed that testicular nitrate/nitrite and TBARS levels were increased in obstructive azoospermia. For that reason, we concluded that antioxidant treatment can be recommended to patients before sperm extraction for artificial reproduction due to obstructive infertility after vasectomy reversal.

Effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate levels in patients with erectile dysfunction.

OBJECTIVES: To investigate the effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate (DHEAS) levels in patients with erectile dysfunction (ED). METHODS: A total of 124 men with a mean age of 45.9 years were included in the study. Group 1 consisted of 78 patients with ED, as determined by the Sexual Health Inventory of Male (SHIM) scale (score less than 21). Group 2 consisted of 46 healthy men with a SHIM score of 21 or greater. The 78 patients with ED took 100 mg sildenafil citrate at least eight times in 1 month. The SHIM scale was administered and serum DHEAS levels measured before and after treatment in the ED group. The serum DHEAS levels were also measured in the control group. The treatment response was defined as positive if the SHIM score was 21 or greater after sildenafil administration. RESULTS: At the end of sildenafil citrate treatment, the serum DHEAS levels and SHIM scores had increased significantly in the ED group (P = 0.013 and P = 0.001, respectively). In groups 1 and 2, the mean pretreatment serum DHEAS level of the men younger than 50 years old was 200.1 +/- 77.9 and 279.4 +/- 125.4 microg/dL, respectively (P = 0.013). The elevation of the serum DHEAS levels and SHIM scores was more significant in the sildenafil responders (P = 0.002 and P = 0.001), respectively. CONCLUSIONS: Serum DHEAS levels were significantly greater in the patients younger than 50 years old than in the older patients in the ED group. The serum DHEAS levels increased significantly after sildenafil citrate treatment in the ED group (especially in the younger men). Also, patient age was an important factor affecting the sildenafil citrate response.

Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation.

OBJECTIVES: To compare the efficacy of sildenafil (Viagra) only, sildenafil plus topical anesthetic cream (EMLA), and topical EMLA-cream-only to that of placebo in treating premature ejaculation. METHODS: A total of 84 patients were enrolled in this study. The duration of premature ejaculation in the patients ranged from 9 to 60 months (mean 32.5 +/- 14.6). Patients were randomized into four groups. Group 1 consisted of 20 patients who took placebo for 2 months. Groups 2 and 3 consisted of 20 and 22 patients, respectively, and they received 50 mg sildenafil 45 minutes before coitus for 2 months. In addition, patients in group 3 applied topical EMLA cream to the glans penis 15 minutes before coitus. The 22 patients in group 4 used topical EMLA-cream-only. After at least eight sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Effectiveness was described as improvement plus cure. RESULTS: The effectiveness was 40% in group 1, 55% in group 2, 86.4% in group 3, and 77.3% in group 4. Of the groups, a significant difference was found in the effectiveness of the treatments (Pearson chi-square= 0.00). No significant difference was found between groups 1 and 2 (P = 0.26). Efficacy was more successful in groups 3 and 4 than in the others (P = 0.00). The difference between groups 3 and 4 was not significant (Pearson chi-square = 0.42). CONCLUSIONS: Sildenafil-only was not superior to placebo or combination treatment. Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment. The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation.