Assessment of the relationship between vitamin D with semen analysis parameters and reproductive hormones levels before and after kidney transplantation: An Iranian randomized and double-blinded study.

BACKGROUND: Vitamin D's role is noticeable on homeostasis of calcium and phosphorous and bone mineralization. Some studies prove that vitamin D has a role in reproductive pathways in male and females and its direct relationship with serum androgen levels in males. The common problem of infertility can be seen in 10%-15% of couples. 25%-50% of all infertilities is due to a male factor, and fertility disturbances are common in male CKD patients. OBJECTIVES: This study aimed to figure out the effect of serum vitamin D levels on semen analysis parameters and reproductive hormones before and after renal transplantation in ESRD patients. METHODS: This double-blind randomized clinical trial was carried out on 70 ESRD males (21-48 years old) who were candidates for renal transplantation at Sina hospital between 2021 and 2022. Participants were divided into two groups randomly. First group was supplemented by vitamin D (50,000 units weakly until 3 months), and no intervention was done in the second group. Vitamin D levels, LH, FSH, creatinine, glomerular filtration rate (GFR), calcium, total and free testosterone, PTH, sexual function, and semen analysis parameters were evaluated in a determined interval before and after (three and 6 months) kidney transplantation. RESULTS: Vitamin D levels were noticeably higher in case group in comparison to the control group (p-value < 0.01) but the difference in all other variables including calcium levels, LH, FSH, total and free testosterone, IIEF-5 score, PTH, GFR, and creatinine was insignificant (p-value > 0.05). The comparison of semen parameters of the case with control group including sperm count, morphology, volume, and motility didn't reveal a noticeable difference between the two groups (p-value > 0.05). CONCLUSION: Prescription of vitamin D as a supplementation doesn't improve sperm quality (sperm count, motility, morphology, and volume) and reproductive hormones (LH, FSH, free and total testosterone) after kidney transplantation in male CKD patients.

Comparison of sexual function changes in recipients of kidney transplant in females receiving kidney from the living donor and deceased donor.

BACKGROUND AND AIM: Chronic renal failure can result in different sexual and reproductive problems for women. Due to lack of information about sexual dysfunction of women with transplanted kidney and superiority of either living or deceased donor, we designed this retrospective cohort study to compare sexual function changes in recipients of kidney transplant in two groups receiving kidney from the living donor and deceased donor using Female Sexual Function Index score. METHODS AND MATERIALS: We included 55 female patients who underwent kidney transplant from 22 May 2015 to 22 May 2016 in Sina Hospital (Tehran, Iran). Laboratory factors, including creatinine, blood urea nitrogen, hemoglobin, fasting blood glucose, triglyceride, cholesterol, low-density lipoprotein, and high-density lipoprotein, were evaluated before and after the transplantation. Female Sexual Function Index questionnaire was used to evaluate sexual function of the patients before the transplant, 3 months after the transplant, and 9 months after the transplant. RESULTS: Our results revealed that there is significant improvement in the Female Sexual Function Index score of the patients after the transplant (p-value < .001). However, we found no significant difference between the scores of the patients with living donor and deceased donor (p-value > .05). Patients' age, creatinine level, low-density lipoprotein, and diastolic blood pressure are negative predictors of Female Sexual Function Index scores.

Effect of penile-extender device in increasing penile size in men with shortened penis: preliminary results.

INTRODUCTION: It has been suggested that the application of penile-extender devices increases penile length and circumference. However, there are a few scientific studies in this field. AIMS: The aim of this study was to assess the efficacy of a penile-extender (Golden Erect(®) , Ronas Tajhiz Teb, Tehran, Iran) in increasing penile size. METHODS: This prospective study was performed on subjects complaining about "short penis" who were presented to our clinic between September 15, 2008 and December 15, 2008. After measuring the penile length in flaccid and stretched forms and penile circumference, patients were instructed to wear Golden Erect(®) , 4-6 hours per day during the first 2 weeks and then 9 hours per day until the end of the third month. The subjects were also trained how to increase the force of the device during determined intervals. The patients were visited at the end of the first and third months, and penile length and circumference were measured and compared with baseline. MAIN OUTCOME MEASURES: The primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow-up. RESULTS: Twenty-three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05). CONCLUSION: Our findings supported the efficacy of the device in increasing penile length. Our result also suggested the possibility of glans penis girth enhancement using penile extender. Performing more studies is recommended.

Intraprostatic botulinum toxin type A injection for the treatment of benign prostatic hyperplasia: Initial experience with Dysport.

OBJECTIVE: To evaluate the effect of intraprostatic botulinum toxin type A (BoNTA, Dysport) injection on lower urinary tract symptoms, prostate-specific antigen (PSA), prostate volume (PV), peak urine flow rate (Q(max)) and postvoiding residue (PVR), and to evaluate the role of PV in the treatment outcome. MATERIAL AND METHODS: Seventy-two men with PSA < 4 ng/ml, International Prostate Symptom Score (IPSS) > or = 8, Q(max) < 12 ml/s and PV < 60 ml were enrolled. A total of 300-600 U Dysport was injected transperineally under transrectal ultrasound guidance. Initial IPSS, quality of life (QoL) score, Q(max) and PVR were compared with their measures at 1, 6 and 12 months after the injection. Initial PSA and PV were compared with their values after 6 months. Parameters were also compared between patients with PV < or = 30 ml and those with PV > 30 ml. RESULTS: The mean age of participants was 63.5 years. At follow-up sessions, IPSS and QoL score were significantly decreased (p < 0.001). PVR reduced significantly and Q(max) increased considerably (p < 0.001). PSA and PV substantially decreased after 6 months (p < 0.001). No serious complications were reported. Similar to patients with larger prostates, IPSS and QoL score decreased statistically significantly after 12 months in those with PV < or = 30 ml; however, changes in PV, PSA, PVR and Q(max) did not persist during 12 months' follow-up. CONCLUSIONS: The procedure is safe and efficacious and the results are comparable to previous experiences with Botox. It seems that the toxin efficacy depends directly on PV in prostates < 60 ml.

Sexual dysfunction in epileptic men.

INTRODUCTION: The aim of this study was to evaluate the frequency of sexual dysfunction among epileptic patients. MATERIALS AND METHODS: Eighty married men between 22 and 50 years with a confirmed diagnosis of epilepsy were enrolled in this study. Patients with other neurological diseases, hypertension, cardiovascular diseases, diabetes mellitus, underlying urogenital diseases, and impaired general health status were excluded. Furthermore, those with mental health problems were identified by the standardized General Health Questionnaire-28 and were excluded. Demographic and clinical characteristics of the disease were evaluated, and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function-15 (IIEF-15). RESULTS: Of 80 patients, 34 (42.5%) had erectile dysfunction. There were no differences between the patients in the 3 age groups in the IIEF scores. Type of seizure had a significant correlation with erectile function score (P = .008). None of the IIEF domains scores were different between the patients with controlled epilepsy and those with uncontrolled epilepsy during the previous 6 months. However, frequency of epileptic seizures (before treatment) correlated with the scores for erectile function (r = 0.31; P = .005), orgasmic function (r = 0.23; P = .04), and sexual desire (r = 0.24; P = .03). CONCLUSION: It seems that the main aspects of sexual activity such as erectile function, orgasmic function, and sexual desire are frequently impaired in epileptic patients. Our findings were also indicative of a higher risk of sexual dysfunction in patients with partial seizures.

Seminal plasma magnesium and premature ejaculation: a case-control study.

OBJECTIVE: To determine the relationship between premature ejaculation (PE) and serum and seminal plasma magnesium levels, in a case-control study. PATIENTS AND METHODS: Thirty-eight patients referred to the authors' urology outpatient clinic were evaluated in two groups; cases comprised 19 men complaining of PE, defined using the Diagnostic and Statistical Manual of Mental Disorders IV criteria and an intravaginal ejaculatory latency time (IELT) of <1 min, and a control group of 19 married men with a normal IELT. All men had a history taken, a systemic physical examination and laboratory studies. After organic and psychogenic disorders were excluded, the 19 patients were included in the study. Seminal plasma and serum magnesium levels were determined using atomic absorption spectrophotometry. RESULTS: The mean (sd) plasma magnesium level was 94.7 (10.9) mg/L in the cases and 116.7 (11.6) mg/L in the controls. There was a significant relationship between seminal plasma magnesium, but not the plasma level, and PE (P < 0.001 and 0.597 respectively). CONCLUSION: PE is significantly related with a lower level of seminal plasma magnesium. The pathological physiology of this relationship requires more investigation.

Improvement of erectile dysfunction after kidney transplantation: the role of the associated factors.

INTRODUCTION: The aim of this study was to evaluate erectile dysfunction (ED) in hemodialysis patients and the factors influencing ED after a successful kidney transplantation. MATERIALS AND METHODS: A total of 64 patients on hemodialysis were evaluated before and 6 months after the kidney transplantation. They were all recipients of their first kidney allografts from living unrelated donors and had a functional kidney allograft during the follow-up. The 5-item version of the International Index of Erectile Function (IIEF-5) was used to assess their erectile function. A group of age-matched controls were compared with them before transplantation. The effects of pretransplant IIEF-5 score, age at transplantation, the artery used for anastomosis, and duration of the dialysis prior to transplantation on ED were also studied. RESULTS: Fifty-six of the patients (87.5%) and 23 of the controls (35.9%) had ED (P < .001). The prevalence of ED was 87.5% in the hemodialysis patients. There was no relationship between the duration of dialysis and the severity of ED. Successful transplantation improved IIEF-5 score significantly (13.6 5.2 before and 19.2 5.0 after transplantation; P < .001). Based on the IIEF-5 scores, the severity of ED increased in 6 (9.4%) patients; 8 (12.5%) experienced no change in their erectile function; and 50 (78.1%) reported an improved erectile function. Preoperative IIEF-5 score and age at transplantation had statistically significant associations with ED improvement (P < .001; P = .02). CONCLUSION: Erectile dysfunction is highly prevalent in hemodialysis patients and significantly improves after successful kidney transplantation. Younger patients with a less severe ED have the most improvement after transplantation.

Posttransplant infectious complications: a prospective study on 142 kidney allograft recipients.

INTRODUCTION: We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality. MATERIALS AND METHODS: A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients' status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed. RESULTS: Infections occurred in 77 patients (54%). The lower urinary (42%) and respiratory (6.3%) tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 (24%) and cytomegalovirus in 25 patients (18%). Wound infection occurred in 7 patients (5%). The mortality rate was 7.7% and infection-related death was seen in 5 patients (3.5%) who developed sepsis. Graft loss was seen in 16 patients (11%), of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare (0.7% and 2.8%, respectively). CONCLUSION: This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection.

Preoperative corporal biopsy as a predictor of postoperative results in venoocclusive erectile dysfunction.

INTRODUCTION: Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction (ED) and whether preoperative corporeal biopsy can help predict postoperative results. MATERIALS AND METHODS: A total of 36 patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction (IIEF) scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months after surgery, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. RESULTS: The mean follow-up was 49.0 +/- 24.1 months. The mean age of the patients with ED was 32.1 +/- 8.6 years. Venous leakage was clearly revealed by cavernosography in all patients, preoperatively. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity (EDV), however, decreased from 11.0 cm/s to 5.1 cm/s (P = .023). Only 2 patients had satisfactory penile rigidity after venous ligation, 2 were helped by intracorporeal injection to achieve full rigidity, and 1 used oral sildenafil to achieve full rigidity. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had a normal histologies, and 2 had a slight decrease of smooth muscle cell mass. CONCLUSION: Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy.

Seminal plasma magnesium and premature ejaculation: a case-control study.

INTRODUCTION: Our aim was to determine the relationship between genuine premature ejaculation and serum and seminal plasma magnesium. MATERIALS AND METHODS: In a case-control study carried out between January 2002 and December 2003, 19 patients with premature ejaculation were evaluated and compared with 19 patients without premature ejaculation. Patients with organic and psychogenic causes were excluded. Seminal plasma and serum magnesium levels were measured using atomic absorption spectrophotometery. RESULTS: Seminal plasma magnesium levels in study patients (94.73 +/- 10.87 mg/L) were significantly lower than they were in controls (116.68 +/- 11.63 mg/L, P < 0.001), but there were no such differences regarding serum magnesium levels (study patients, 20.26 +/- 2.66 mg/L; controls, 20.73 +/- 2.80 mg/L). Semen-to-serum-magnesium ratio was significantly lower in patients with premature ejaculation (P < 0.001). Also, a reverse relationship between body mass index and genuine premature ejaculation was found (P = 0.027). CONCLUSION: Genuine premature ejaculation has a significant relationship with decreased levels of seminal plasma magnesium. Further studies are needed to clarify the actual role of magnesium in the physiology of the male reproductive tract, especially its association with premature ejaculation.

The relationship between lipid profile and erectile dysfunction.

PURPOSE: To evaluate the relationship between serum lipids including cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride and erectile dysfunction (ED). MATERIALS AND METHODS: From January 2000 to June 2003, 100 patients with organic ED, who were referred to our center, were selected and their lipid profile (Cholesterol, Triglyceride, HDL, LDL) were assessed. The results were compared with those in 100 healthy individuals. RESULTS: Mean age of men in the study and control groups were 43.72 +/- 9.76 and 43.59 +/- 10.51 years, respectively. Mean plasma cholesterol and LDL levels in individuals suffering from erectile dysfunction were significantly higher than controls (P = 0.04 and P = 0.02, respectively). However, no difference in the mean plasma triglyceride and HDL levels was seen. Odds Ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97, respectively (r2 = 0.04 and r2 = 0.04). Using linear regression analysis, the regression coefficient for cholesterol and LDL versus the International Index of Erectile Dysfunction Questionnaire (IIEF) score were -0.036 and -0.035, respectively (95% confidence interval: 0.98 - 2.5 for cholesterol and 1.13 - 2.81 for LDL). CONCLUSION: The impact of total cholesterol and particularly LDL on men's erectile function underlines the role of hyperlipidemia treatment in prevention of ED and emerges a holistic management in ED patients.

The role of ureteroscopy in the treatment of renal transplantation complications.

INTRODUCTION: To determine the feasibility, safety, and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. MATERIALS AND METHODS: We reviewed 1560 consecutive renal allografts have been preformed between June 1989 and February 2002.Twenty-eight patients (1.8%) had indication for endoscopic procedure on allograft ureter. Six patients had obstructive ureteral calculi with a history of failed ESWL, 3 had suspected ureteral stricture, 9 had upward migrated ureteral stents and 10 had ureteral stricture at ureteroneocystostomy site. Ureters were anastomosed to bladder using Leadbetter- Politano and Lich-GreGoire methods in 6 and 22 cases, respectively. Ureteroscopies were performed with semi rigid 9.8F wolf ureteroscope. RESULTS: Identifying and introducing the ureteral orifice was successful in 19(68%) cases. If we exclude 10 patients with ureteral stricture, ureteroscopy was successful in 13 out of 18 (72%). Four ureteral calculi (67%) were removed with ureteroscope.Seven out of nine migrated stents (78%) were retrieved. Four patients with ureteral stricture at ureteroneocystostomy site (40%) had successful ureteral dilatation and double J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications including one urinary leakage and one symptomatic urinary tract infection occurred that were managed conservatively. CONCLUSION: Ureteral endoscopy was safe and effective method for management of urological complications after RT (renal transplantation). This procedure can be considered as the first choice compared with percutaneous and antegrade modalities.