Glans penis volume is associated with lifelong premature ejaculation.

BACKGROUND: Although premature ejaculation (PE) is the most common male sexual dysfunction, the underlying mechanisms are not fully understood. AIM: The study sought to evaluate the possible associations among glans penis volume and tissue stiffness measured using penile ultrasonography and penile shear wave elastography (SWE) with PE. METHODS: Men 18 to 65 years of age with normal International Index of Erectile Function scores (>25) and who were diagnosed with PE between June 2021 and June 2022 were enrolled. The Premature Ejaculation Diagnostic Tool score and intravaginal ejaculation latency times were recorded. Healthy volunteers constituted the control group. The study group was divided into lifelong PE (LLPE) and acquired PE (AqPE) subgroups. In all groups, the glans penis volume was measured via penile ultrasonography and tissue stiffness of the glans penis, penile frenulum, postcircumcision mucosal cuff, and penile shaft were measured via SWE. The findings of the groups were compared using appropriate statistical methods. OUTCOMES: The outcomes included ultrasonographic and elastographic measurements of the glans penis. RESULTS: Data on 140 men, including 70 PE patients and 70 healthy volunteers, were evaluated. Of the patients, 20 had LLPE and 50 had AqPE. The median glans penis volume was significantly greater in the LLPE group (14.1 [range, 6.6-19] mm3) compared with the AqPE group (11.7 [range, 5.1-27] mm3) and control group (11.4 [range, 6.1-32] mm3) (P = .03). According to the Youden index, the best cutoff value for glans penis volume in LLPE compared with non-LLPE (AqPE + control) was 12.65 mm3 (area under the curve, 0.684; 95% confidence interval, 0.556-0.812; P = .009). The risk of having LLPE in those with a glans penis volume ≥12.65 mm3 was 3.326 (95% confidence interval, 1.234-8.965) times higher than the non-LLPE group (P = .014). There were no significant differences between the groups in the SWE evaluation of glans penis, penile frenulum, mucosal cuff, and penile shaft tissue stiffness. CLINICAL IMPLICATIONS: The high incidence of PE in those with high glans penis volume may make glans penis volume a predictor for the development of LLPE. STRENGTHS AND LIMITATIONS: This was the first study to show that PE is more common in individuals with a high glans penis volume. It was also the first to perform a penile elastographic evaluation in patients with PE. The most important limitation was that we did not evaluate glans penile nerve function with a test, but rather we made an indirect inference about the density of free nerve endings based on increased glans penile volume. CONCLUSION: Glans penis volume was a significant predictor for LLPE. However, there are no associations between PE and the glans penis, postcircumcision mucosal cuff, penile frenulum, or penile shaft tissue stiffness and development.

The importance of inquiring the ejaculation function in men with premature ejaculation who do not actively seek treatment.

PURPOSE: To evaluate the clinical characteristics of men presenting for other complaints whose ejaculatory function inquiry indicated premature ejaculation (PE). METHODS: The data of 536 PE patients, including those who presented with the complaint of PE (group 1) and those presenting with other complaints who were diagnosed with PE (group 2) as a result of ejaculatory function inquiry using estimated intravaginal ejaculation latency time (IELT) and Premature Ejaculation Diagnostic Tool (PEDT), were retrospectively evaluated. Age, PE type, comorbidities, recommended treatments, and treatment acceptance status of all patients were recorded. These characteristics were compared for each group. RESULTS: Among all the patients, those who presented with PE complaints constituted 22.4%. Among the patients with both PE and ED, 98.1% applied with ED complaint and only 1.9% with PE complaint. The percentage of patients with one comorbidity was significantly higher in group 2 (p = 0.032). 90.1% of all patients and 88.5% of patients in group 2 accepted the recommended treatment for PE. The mean age and comorbidities were significantly higher in patients that refused the treatment. The most common reason for treatment refusal was the patients' lack of expectation for treatment. CONCLUSIONS: This study shows that men more frequently tend to seek treatment for ED than PE, and treatment acceptance rate may be higher when the patients with PE complaints who don't seek treatment are reached through ejaculatory function inquiry. The presence of comorbidities negatively affects the treatment expectation and acceptance as well as treatment seeking behavior of men with PE.

Male sexual functions and behaviors in the age of COVID-19: Evaluation of mid-term effects with online cross-sectional survey study.

OBJECTIVE: To evaluate the long-term effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual functions and behavior in men with heterosexual partners. MATERIALS AND METHODS: A total of 602 participants completed an online questionnaire, shared via social networks, between November 20 and December 20, 2020. Pre-pandemic sexual intercourse frequency, International Erectile Dysfunction Index (IIEF-15) score, intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT) score, and activities during sexual intercourse were compared to the ones during the pandemic. In addition, the effects of various variables on participants' sexual functions were evaluated and analyzed according to age groups. RESULTS: The mean number of weekly sexual intercourse during the pandemic was 1.7+1.7, which was significantly lower than in the pre-pandemic period (p < 0.001). The ED score was significantly lower during the pandemic (p < 0.001) compared to the pre-pandemic period, however orgasmic function (p = 0.016), sexual intercourse satisfaction (p < 0.001), general satisfaction (p < 0.001), and PEDT scores (p = 0.004) were significantly higher. There was no significant difference in IELT before and during the pandemic (p = 0.391). Full-time employment and low education level were risk factors for developing ED and PE. The negative affect of the pandemic on sexual life was most prominent in the > 65 age group. Although kissing, oral and anal sex, and face-to-face sex positions decreased during the pandemic in all age groups, kissing and face-to-face sex positions remained the most preferred sexual behavior pattern (p = 0.002). There was no reduction in risky sexual behavior in the majority of the participants. CONCLUSIONS: At the end of one year with COVID-19, a decrease in erectile function and an increase in PE incidence were observed in men. Despite this, there was an increase in sexual desire and satisfaction. Although there were some changes in sexual behavior, the majority of pre-pandemic habits continued.

A giant adrenal hemorrhagic pseudocyst mimicking a parapelvic renal cyst: A case report and review of the literature.

Adrenal pseudocysts are rare, nonfunctional, asymptomatic cystic masses that originate from the adrenal gland and are usually located in the suprarenal area. They are usually incidentally discovered during imaging, but diagnosis can be challenging because they are similar to benign and malignant cystic lesions of the adrenal gland and adjacent organs. We describe a giant, adrenal hemorrhagic pseudocyst that was atypically located, extending from the middle to the lower poles of the kidney, admixed with a renal cortical cyst.

Management of urinary tract infection with intravesical amikacin may increase the risk of bladder oxidative stress in children with neurogenic bladder.

INTRODUCTION: We evaluated the bladder oxidative stress in neurogenic bladder children treated with intravesical amikacin for recurrent UTI and whether urinary isoprostane f2 alpha (F2-IsoP) is a good biomarker in this particular condition. METHODS: This prospectively designed controlled study was approved by the Adnan Menderes University institutional ethics committee (Adnan Menderes University, 2015/649). Between January 2016 and January 2017, twenty-six children with meningomyelocele who had been doing CIC were recruited. Serum and urine samples were collected during urinary tract infection (UTI) (group 1) and after management of UTI with intravesical amikacin (group 2) besides standard oral antibiotic treatment. While oxidative stress parameters SOD, GSH, GPX, MDA, F2-IsoP and NO were analyzed in the serum samples, only F2-IsoP was analyzed in the urine. All data were compared with 23 normal healthy control children (group 3). RESULTS: Median age, CIC duration and number of CIC per day of patients' group were 84 (60-147) months, 60 (30-90) months and 4 (4-6), respectively. Male-to-female ratio was 1:16. There was no statistical difference between groups in terms of serum oxidative stress parameters (p > 0.05). However, statistically significant urine F2-IsoP changes exist between groups (p = 0.011) (Fig. 1). But there were no correlations between urine F2-IsoP and disease clinical data such as CIC duration or number of CIC per day. Serum glutathione levels in group 2 were higher than group 1 and 3, as well (p = 0.023, Kruskal-Wallis test). Fig. 1 Comparison of median urinary isoprostane f2 alpha levels CONCLUSION: Higher urine F2-IsoP levels after management of UTI with intravesical amikacin may reflect increased lipid peroxidation and oxidative stress in children with NB. This detrimental effect on bladder should be considered in the long-term treatment period.

Role of Contrast Enhancement and Corrected Attenuation Values of Renal Tumors in Predicting Renal Cell Carcinoma (RCC) Subtypes: Protocol for a Triphasic Multi-Slice Computed Tomography (CT) Procedure.

BACKGROUND: To distinguish RCC subtypes based on contrast enhancement features of CT images. MATERIAL/METHODS: In total, 59 lesions from 57 patients were included. All patients underwent multi-slice CT imaging with a triphasic protocol, which included non-contrast, corticomedullary, nephrographic and urographic phases. Contrast enhancement features of renal masses were evaluated in terms of CT attenuation values (AV) and differences in contrast density; the aorta or renal parenchyma were evaluated based on corrected or relative values. RESULTS: Clear cell RCC (ccRCC) showed more intense contrast enhancement than other RCC subtypes. When differentiating ccRCC from other RCC subtypes, a cut-off AV of 86-89 HU, aorta-based corrected AV of 89-95 HU and renal parenchyma-based corrected AV of 87-95 HU showed a diagnostic accuracy of 81-86%, 86-88% and 74-78%, respectively, in the corticomedullary phase. Furthermore, a cutoff of 2.42-2.72 for the relative contrast enhancement ratio, a cutoff of 2.59-2.74 for the aorta-based corrected relative contrast enhancement ratio and a cutoff of 2.63-2.76 for the renal parenchyma-based attenuation ratio showed a diagnostic accuracy of 83-88%, 88-90% and 81%, respectively. CONCLUSIONS: The most reliable parameters for differentiating ccRCC from other RCC subtypes are aorta-based corrected AV and aorta-based corrected relative contrast enhancement values in the corticomedullary phase.

Laparoscopic Dismembered Pyeloplasty in a Solitary Kidney with Intrarenal Pelvis: Two Challenges in One Case.

Laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is one of the most appropriate surgical techniques to achieve the optimal goal of minimally invasive surgery. However, urologists hesitate to use the laparoscopic approach in UPJO with solitary kidney or intrarenal pelvis. There are a few published studies on laparoscopic pyeloplasty cases in intrarenal pelvis. However, to the best of our knowledge, the present case is the first in the literature in terms of intrarenal pelvis in a solitary kidney. Generally, YV plasty is the accepted technique instead of dismembered pyeloplasty in UPJO with small or intrarenal pelvis. However, in this report, we showed that dismembered LP can be performed with good results in intrarenal pelvis UPJO, even if it is in the solitary kidney.

The protective effect of tadalafil on IMA (ischemia modified albumin) levels in experimental renal ischemia-reperfusion injury.

INTRODUCTION: To investigate the effect of the tadalafil in experimental renal I/R injury and to evaluate these changes with IMA (nonspesific early biomarker of ischemia), NO and MDA levels. MATERIALS AND METHODS: Twenty four female Wistar rats were randomly divided into 3 groups (n=8): Group I, sham; Group II, 60 min I/R; Group III, 60 min I/R plus tadalafil. Tadalafil was administered via an orogastric tube (10 mg/kg) 24 h prior to the procedure. After ischemia of the left kidney and 1 h of reperfusion, blood samples were obtained, and the kidney was removed. RESULTS: Statistically significant histopathologic changes were exist between groups, with the most severe injury was determined in group II in comparison to the others (X(2)=21,803, P=0.000). Also mean serum IMA levels were higher in group II, but not statistically significant (19.83±7.81 U/ml, 22.26±7.14 U/ml and 19.82±7.77 U/ml, P=0.613). In addition, NO values were lower in I/R groups (P=0.049). There were no differences among the groups in terms of MDA. CONCLUSIONS: IMA may be used as a nonselective biomarker for IR injury before the occurrence of necrosis. Decreased IMA levels may indicate the nephroprotective effect of tadalafil in renal IR injury.

A rare cause of testicular metastasis: upper tract urothelial carcinoma.

Metastatic testicular cancers are rare. Primary tumor sources are prostate, lung, and gastrointestinal tract for metastatic testicular cancers. Metastasis of urothelial carcinoma (UC) to the testis is extremely rare. Two-thirds of upper tract urothelial carcinoma (UTUC) is of invasive stage at diagnosis and metastatic sites are the pelvic lymph nodes, liver, lung, and bone. We report a rare case of metastatic UTUC to the testis which has not been reported before, except one case in the literature. Testicular metastasis of UC should be considered in patients with hematuria and testicular swelling.

Malnutrition due to bisphosphonate-related osteonecrosis of the jaw in a chronic dialysis patient: case report.

Adequate nutrition is imperative for a successful outcome in dialysis patients. Excellent oral hygiene and an efficient mastication can help to correct several metabolic and endocrine disturbances as well as delay initiation of dialysis in patients with chronic renal failure. However, concerns exist about the risk of malnutrition and protein depletion. On the other hand, intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. This complication occurs either spontaneously or after minor dento-alveolar surgery including extraction of teeth. A malnourished dialysis patient who showed the typical clinical features of bisphosphonate-related osteonecrosis of the jaw (BRONJ) without any obvious radiological changes in his panoramic radiograph is reported. To minimize the risk of BRONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral health evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy.

Erectile function and late-onset hypogonadism symptoms related to lower urinary tract symptom severity in elderly men.

The aim of this study was to evaluate the relationship between lower urinary tract symptoms (LUTSs), erectile dysfunction (ED) and symptomatic late-onset hypogonadism (SLOH) in ageing men in the Aegean region of Turkey. Five hundred consecutive patients >40 years old who had been in a steady sexual relationship for the past 6 months and were admitted to one of six urology clinics were included in the study. Serum prostate-specific antigen and testosterone levels and urinary flow rates were measured. All patients filled out the International Prostate Symptom Score and Quality of Life (IPSS-QoL), International Index of Erectile Function (IIEF) and Aging Males' Symptoms (AMS) scale forms. Of the patients, 23.9% had mild LUTSs, 53.3% had moderate LUTSs and 22.8% had severe LUTSs. The total testosterone level did not differ between groups. Additionally, 69.6% had ED. The presence of impotence increased with increasing LUTS severity. Symptomatic late-onset hypogonadism (AMS >27) was observed in 71.2% of the patients. The prevalence of severe hypogonadism symptoms increased with the IPSS scores. A correlation analysis revealed that all three questionnaire scores were significantly correlated. In conclusion, LUTS severity is an age-independent risk factor for ED and SLOH. LUTS severity and SLOH symptoms appear to have a strong link that requires etiological and biological clarification in future studies.

The diagnostic efficiency of ultrasound guided imaging algorithm in evaluation of patients with hematuria.

PURPOSE: To assess the efficiency of the following imaging algorithm, including intravenous urography (IVU) or computed tomography urography (CTU) based on ultrasonographic (US) selection, in the radiological management of hematuria. MATERIALS AND METHODS: One hundred and forty-one patients with hematuria were prospectively evaluated. Group 1 included 106 cases with normal or nearly normal US result and then they were examined with IVU. Group 2 was composed of the remaining 35 cases which had any urinary tract abnormality, and they were directed to CTU. Radiological results were compared with clinical diagnosis. RESULTS: Ultrasonography and IVU results of 97 cases were congruent in group 1. Eight simple cysts were detected with US and 1 non-obstructing ureter stone was detected with IVU in remaining 9 patients. The only discordant case in clinical comparison was found to have urinary bladder cancer on conventional cystoscopy. Ultrasonography and CTU results were congruent in 30 cases. Additional lesions were detected with CTU (3 ureter stones, 1 ureter TCC, 1 advanced RCC) in remaining 5 patients. Ultrasonography+CTU combination results were all concordant with clinical diagnosis. Except 1 case, radio-clinical agreement was achieved. CONCLUSION: Cross-sectional imaging modalities are preferred in evaluation of hematuria. CTU is the method of choice; however the limitations preclude using CTU as first line or screening test. Ultrasonography is now being accepted as a first line imaging modality with the increased sensitivity in mass detection compared to IVU. The US guided imaging algorithm can be used effectively in radiological approach to hematuria.

Can the effect of antibiotherapy and anti-inflammatory therapy on serum PSA levels discriminate between benign and malign prostatic pathologies?

OBJECTIVE: The primary aim was to evaluate the change in the total and free PSA levels after antibiotic and non-steroid anti-inflammatory treatment. The secondary aim was to compare this change among the histological subgroups to assess whether it was discriminating. METHODS: 97 consecutive patients with PSA >4 ng/dl and scheduled for prostate biopsy were included in this prospective study. 65 patients (group 1) were then put on medical treatment of ciprofloxacin 500 mg bid and diclofenac sodium 75 mg during the routine waiting period before the 2- to 3-week procedure. Randomly selected (every third case) 32 patients (group 2) did not receive this treatment. Free and total PSA tests were repeated before the procedure. The change in the PSA values was compared between the groups and among the histological subgroups in group 1. RESULTS: While in group 1 the decrease in PSA was significant (p = 0.000), this was not the case in group 2. The difference in free PSA values was unremarkable for both groups. In histologically determined cancer cases of group 1, the difference between pre- and post-procedure PSA level was not of note, while in BPH and prostatitis cases it was significant. CONCLUSION: In cases with increased PSA, medical treatment for a likely subclinical prostatitis resulted in a decrease of PSA, which was significant only in benign conditions.

Determination of apoptosis through bax expression in cryptorchid testis: an experimental study.

The aim was to determine the expression of Bax in germ cells of rats with unilateral experimental cryptorchidism, and to evaluate the role of apoptosis in germ cell loss. Twenty-one prepubertal rats were randomly subdivided into three groups after the execution of the left cryptorchidism model. Group 1 (n=8), group 2 (n=6) and group 3 (n=7) rats were killed at the end of the first, second and third month, respectively. Bax expression was assessed in Sertoli cells, spermatogonia and spermatocytes by immunohistochemistry. Percentages of Bax expression in spermatocytes and spermatogonia were decreased in the left testicles in the 2nd and 3rd months compared to results obtained in the 1st month (p<0.05). Percentage of Bax expression in the left testicles of group 1, at the level of both spermatogonia and spermatocytes was higher than that in the right one (p<0.05). However, in groups 2 and 3, the higher Bax expression on the left side was only seen in the spermatocytes (p<0.05). In all groups, the mean weight of the left testicle was lower than that of the scrotal counterpart where the difference was significant only in groups 1 and 3 (p<0.05). The weight of the left and right testicles was increasing with time. In this model of cryptorchidism, the affected testis had a decreased weight compared to the normal one. Based on the increased Bax expression, we think that apoptosis may play a role in the germ cell loss.

Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life.

OBJECTIVES: To determine the prevalence and risk factors of urinary incontinence (UI), and to assess its impact on quality of life (QOL) in Turkish women. METHODS: In this cross-sectional study, 1012 women aged over 18 years were interviewed through a questionnaire including 'International Consultation on Incontinence Questionnaire Short Form'. RESULTS: The overall prevalence of UI was 23.9% (n=242). Among these women, 62 (25.6%) had urge, 80 (33.1%) stress and 100 (41.3%) mixed type UI. The prevalence rate increased with advancing age. Eighty-nine women (36.8%) stated to have urinary leakage at least once a day or more, while 153 (63.2%) women were experiencing less than twice a week. UI was significantly associated with fecal incontinence, hypertension, history of nocturnal enuresis, and recurrent urinary tract infections. Overall, 211 (87.2%) women stated that UI have negative impact on the QOL. This effect remained mostly at the mild or moderate level. Although many (87.2%) had intention for medical assistance, only a few (14.9%) had realized it. Women with urge UI and aged 40 to 50 years looked for more assistance than others. CONCLUSIONS: UI affect approximately one of four Turkish women. The results emphasize the need for taking preventive measures and policy development for UI.

The value of contrast enhanced power Doppler ultrasonography in differentiating hypoehoic lesions in the peripheral zone of prostate.

OBJECTIVE: To characterize the hypoechoic prostate nodules in the peripheral zone by means of power Doppler ultrasonography (PDUS) and contrast enhanced PDUS (CE-PDUS). MATERIALS AND METHODS: Thirty-two patients with dijital rectal examination findings suspicious for malignancy and/or a serum PSA level higher than 4 ng/dl, and who had hypoechoic nodules on transrectal ultrasonography were enrolled in this prospective study. Power Doppler ultrasonography (PDUS) images before and after sonocontrast (Levovist) injection were photographed for further evaluation. All patients were also evaluated by a systematic and nodule targeted biopsy approach. The photographs were re-evaluated by two radiologists for the presence and type of vascularity. The type of vascularity was categorized as peripheral, central, mixed and penetrating. The latter two were accepted as representatives of malignancy. The results of PDUS and CE-PDUS were compared to each other and to the pathological results. RESULTS: There was a high level of interobserver agreement (Kappa: 0.80-0.95). Nineteen patients, but only 14 nodules were malignant on pathological examination. Sensitivity, specificity positive and negative predictive values for PDUS were 57, 50, 47, and 60%, respectively. On CE-PDUS, the sensitivity increased (93%) in expense of specifity (17%). The positive and negative predictive values were 46 and 75%, respectively. There was no significant difference between PDUS and CE-PDUS. CONCLUSION: This study revealed that both benign and malignant nodules might be hypervascular and show malignant type of vascularity on PDUS. Contrary to some recent reports, we can conclude that the CE-PDUS does not provide a considerable aid to the diagnosis of prostate carcinoma on morphological basis due to its very low specificity despite its relatively higher sensitivity.

The effect of diltiazem on the healing of traumatic urethral inflammation.

OBJECTIVE: To investigate the effect of diltiazem, a calcium channel blocker, on healing of the traumatic urethral inflammation when applied systemically or locally. MATERIALS AND METHODS: 21 adult male Wistar rats (230-250 g) were assigned to group 1 (n = 7) = control, group 2 (n = 7) = local application or group 3 (n = 7) = systemic application. In group 1, only a urethral injury was achieved at the 12-o'clock position by gently introducing and drawing a tiny hook in the urethra until urethral bleeding occurred. In group 2, after the same procedure, 10 mg/kg diltiazem was applied retrogradely via a 22-gauge Angiocath intraurethrally for 5 consecutive days, while the same account of the drug was administered intraperitoneally in group 3. After 21 days, the rats were sacrificed for urethrectomy. Pathologically, the thickness of connective tissue, the regularity of the epithelial lining, the presence of the inflammation and the density of collagen were evaluated with Masson's trichrome staining. The Mann-Whitney U test was used for statistical analyses. RESULTS: The mean connective tissue thickness was 0.77 +/- 0.39, 1.01 +/- 0.77 and 0.93 +/- 0.53 microm in groups 1, 2 and 3, respectively. The differences between the groups were insignificant (p > 0.05). The hyperplastic epithelial lining in the study groups, with both systemic and local applications, was markedly infrequent and the inflammation was less prominent. However, these differences did not reach statistical significance. CONCLUSIONS: Diltiazem appears not to have any preventive effect on connective tissue formation when applied locally or systemically in our urethral injury model.