Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients.

INTRODUCTION: Chronic renal failure (CRF) and renal replacement treatments have a negative effect on sexual function and quality of life (QoL). The literature on female sexual dysfunction (FSD) in patients with CRF is limited. The aim of this study is to compare the sexual function and QoL in predialysis (PreD), dialysis, and transplant patients. MATERIALS AND METHODS: A total of 106 women including 21 PreD, 45 dialysis, 20 renal transplantation (Tx), and 20 control patients were enrolled in the study. The Female Sexual Function Index (FSFI) and SF-36 scales were used to assess all patients, and demographic and clinical variables were documented. The FSFI and QoL scale scores were compared among the groups. RESULTS: The rates of FSD were 50, 81, 66.7, 75, and 50% in the control, PreD, peritoneal dialysis (PD), hemodialysis (HD) and Tx patients respectively. Total FSFI scores for desire, arousal and orgasm scores in the PreD group were significantly lower than those in Tx and control patients (P < 0.05). Physical components of QoL in CRF patients were significantly worse than in the control group (P < 0.0001). On logistic regression analysis, age, glucose and creatinine were significantly associated with FSD. CONCLUSION: This preliminary study documented that Tx is the most effective way to retain good sexual function in women, and a diagnosis of FSD should be made routinely in CRF patients.

Can bipolar vaporization be considered an alternative energy source in the endoscopic treatment of urethral strictures and bladder neck contracture?

OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic(TM) cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2%) and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max) was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful" in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20). RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3% for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60% with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.

Can bipolar vaporization be considered an alternative energy source in the endoscopic treatment of urethral strictures and bladder neck contracture?

OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic™ cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2 percent) and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max) was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful” in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20). RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3 percent for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60 percent with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.

Endoscopic treatment of vesicoureteral reflux with polydimethylsiloxane in adults: do location and appearance of the ureteric orifice have a role in the success rates?

INTRODUCTION: Low success rate for high grade reflux and anatomical abnormality of ureteric orifices continues to be the most important dilemma of the endoscopic treatment of vesicoureteral reflux (VUR). The aim of this study was to evaluate the efficacy of endoscopic polydimethylsiloxane injection in adults with VUR concerning reflux severity and the status of the ureteric orifice. MATERIALS AND METHODS: Fifty-three ureters (34 patients) were treated with endoscopic polydimethylsiloxane injection. The grade of VUR was I, II, III, IV and V in 2, 13, 25, 10 and 3 ureters, respectively. Any endoscopic characteristics of 'golf hole', broad appearance or lateral placement of ureteric orifices were classified as complex appearance ureters (CAU). Patients with persistent reflux were considered for second and third injections with the same material. Success was determined as no reflux. RESULTS: The total success rate was 100, 92.30, 92, 80 and 66.66% for grade I, II, III, IV and V reflux after the third injection, respectively. The cure rates of ureters with normal appearance were 100, 88.88, 90, 100 and 100% for grade I, II, III, IV and V reflux. The cure rates of CAU were 100% for both grade II and III, 60% for grade IV and 50% for grade V reflux. The injected volumes per renal unit ranged between 0.2 and 3.2 ml (mean 1.05 ml). CONCLUSIONS: Although there are disadvantages in the usage of higher volumes of injectable material for successful results and difficulty in subureteral injection both in high grade reflux and complex anatomical situations in adults when compared to children, our results indicate that endoscopic treatment of VUR is an effective therapy for adults.