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.

Chronic administration of sildenafil improves erectile function in a rat model of chronic renal failure.

The relationship between erectile dysfunction (ED) and chronic renal failure (CRF) has been reported in several studies. This study aimed to investigate whether the chronic use of sildenafil could enhance the erectile capacity in CRF-induced rats. In addition, we assessed the effect of that treatment on certain molecules, which have been suggested to play crucial roles in erectile physiology and CRF-related ED as well. Three groups of animals were utilized: (1) age-matched control rats, (2) CRF-induced rats, (3) CRF-induced rats treated with chronic administration of sildenafil (5 mg kg-1 p.o. for 6 weeks [treatment started after 6 weeks of CRF induction]). At 3 months, all animals underwent cavernosal nerve stimulation (CNS) to assess erectile function. Penile tissue advanced glycation end products (AGE's)/5-hydroxymethyl-2-furaldehyde, malondialdehyde (MDA), cGMP (ELISA), inducible nitric oxide synthase (iNOS) and neuronal NOS (nNOS) (Western blot) analyses were performed in all rat groups. CRF-induced rats had a significant decrease in erectile function when compared to control rats (P < 0.05). The increase in both intracavernosal pressure (ICP) and area under the curve of CRF-induced rats treated with sildenafil (Group 3) was greater than CRF-induced rats (Group 2). Additionally, sildenafil treatment decreased AGE, MDA and iNOS levels, while it preserved nNOS and cGMP contents in CRF-induced penile tissue. Decreased AGE, MDA, iNOS and increased nNOS, cGMP levels at the sildenafil-treated group increased both ICP and Total ICP to CNS, which led to improve erectile function in CRF-induced rats. The results of the present study revealed the therapeutic effect of chronic sildenafil administration on erectile function in CRF-induced rats.

Diagnosis of testicular torsion by measuring attenuation of dual wavelengths in transmission geometry across the testis: an experimental study in a rat model.

OBJECTIVE: To develop a noninvasive and real-time dual-wavelengths optic system to detect testicular torsion in an animal model. Diagnosis of testicular torsion is challenging in emergency conditions and frequently ends with surgical exploration. MATERIALS AND METHODS: In this study, 9 male 8-month-old Wistar albino rats weighing an average of 400 g were used. A transverse incision on the upper scrotum was done and the right testis was torsed with a 720° medial rotation. The other testis of each rat was used as the control or sham group. In the sham group, the testicle was moved out of the body but no torsion was applied before repositioning into the scrotum. Transmission of continuous-wave light through all testes at wavelengths of 660 nm and 940 nm were measured. RESULTS: The ratio of the average intensities of the transmitted light of both wavelengths--660 nm to 940 nm--was used as a parameter to diagnose testis torsion. The ratios were significantly different (P = .001) between the torsion group and control group. CONCLUSION: Our noninvasive technique measuring attenuation of dual wavelengths in transmission geometry across the testis has the ability to distinguish between the testis with and without torsion on the basis of a threshold value of the ratio.

Anticholinergics do not improve cure rate of alarm treatment of monosymptomatic nocturnal enuresis.

OBJECTIVES: To determine whether previous anticholinergic therapy or a combination of anticholinergics and alarm treatment could increase the success rates for monosymptomatic nocturnal enuresis. Alarm treatment of monosymptomatic nocturnal enuresis is the treatment of choice, with the greatest lasting success. It has been proposed that failures are related to a patient's small bladder volume. METHODS: During a 3-year period (July 2004 to July 2007), all bed-wetting patients presenting to our pediatric urology clinic were retrospectively evaluated. Of 221 enuretic patients, 142 were monosymptomatic and 85 of them had had no previous treatment. The children were treated conservatively, and those with treatment failure were given either alarm treatment or anticholinergics, as chosen by the parents. The patients with failure to the second-line treatment were given a combination of alarm therapy and anticholinergics. RESULTS: The mean age of the 85 children was 8.2 years. Of the 85 children, 30 were first given anticholinergics and 55 alarm treatment. Anticholinergics alone resulted in a 10% success rate and alarm treatment alone, a 56.3% success rate. Previous anticholinergic medication did not increase the success rate of alarm treatment (33.3%). Similarly, adding anticholinergics after alarm treatment had failed did not result in treatment success. We observed no difference in the changes in the mean functional bladder capacities among the anticholinergic treatment arm, alarm treatment arm, or combination arm. CONCLUSIONS: Switching from previous anticholinergic treatment that has failed to alarm treatment or using a combination of alarm treatment and anticholinergics did not improve the functional bladder volume or cure rate of children with monosymptomatic nocturnal enuresis.

Initial pre-scrotal approach for palpable cryptorchid testis: results during a 3-year period.

PURPOSE: Pre-scrotal orchiopexy is emerging as an alternative approach for cryptorchid testes that can be preoperatively mobilized into the scrotum. We present our 3-year pre-scrotal orchiopexy series for all palpable cryptorchid testes regardless of their mobility into the scrotum preoperatively. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent pre-scrotal orchiopexy during a 3-year period. Data collected included preoperative and postoperative testicular position, mobility of the testis into the scrotum preoperatively or with the patient under general anesthesia, patency of processus vaginalis, operative times and complications. RESULTS: A total of 88 cryptorchid testes were treated using single pre-scrotal incision orchiopexy. Mean patient age was 4.9 years. Of the testes 74 (84.1%) could be milked down to the scrotum preoperatively and 14 (15.9%) could not. Of the 14 immobile testes 8 were intracanalicular and 6 were in the superficial inguinal pouch. Pre-scrotal orchiopexy was successful in all 74 testes that were mobilized into the scrotum preoperatively. However, 6 of 14 testes (43%) that could not be moved to the scrotum were effectively managed by a single pre-scrotal incision, while 8 (57%) required an additional groin incision for successful orchiopexy. No complications were observed during a mean followup of 7.1 months. CONCLUSIONS: Orchiopexy using a pre-scrotal approach is a viable alternative for palpable cryptorchid testes that can be preoperatively mobilized into the scrotum. Cryptorchid testes that are palpable but cannot be moved to the scrotum can be managed by the pre-scrotal approach alone in 40% of cases or with an additional groin incision in 60%.

Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center.

AIM: Ureteroscopy in children with miniaturized instruments is becoming popular with the advent of pediatric ureteroscopes and laser lithotriptors. We had been performing pediatric ureteroscopies with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor, used in adults as well. Herein, we present our experience in pediatric ureteroscopy with a semirigid 7.5 Fr. ureteroscope and pneumatic lithotriptor with a specific focus on changes in success and complication rates with time. MATERIALS METHODS: We retrospectively reviewed the charts of all patients younger than 18 years old who underwent ureteroscopic intervention with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor at our institute between January 2000 and September 2009. Patient characteristics were recorded including date of surgery, age, sex, stone size and location, ureteroscopy technique, duration of surgery, the result of surgery, complication, postureteroscopy ureteral stenting, follow-up duration and final imaging. RESULTS: A total of 48 children (28 boys, 20 girls) with a mean age of 7.6 years (range: 9 months-18 years) have undergone 54 ureteroscopic intervention. Thirty-eight (79.1%) children were <10 years of age and 17 (35.4%) were <4 years of age. Stone-related ureteroscopy number was 51. Mean stone diameter was 6.6 mm (4-20 mm). Mean duration of surgery was 77 min (25-150 min). Overall success rate was 84.3%, and overall complication rate was 14.8%. CONCLUSIONS: Ureteroscopic management of ureteral stones is safe and effective in children >1 year of age with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor.