Sexual dysfunction in women with clinical hypothyroidism and subclinical hypothyroidism.

INTRODUCTION: Hypothyroidism is a common hormonal disorder in women that may affect the phases of female sexual function. AIM: To investigate female sexual function in patients with clinic hypothyroidism and subclinic hypothyroidism. METHODS: A total of 25 women with clinic hypothyroidism (group 4), 25 women with subclinic hypothyroidism [thyroid stimulating hormone (TSH) value 10 mU/L (group 3)], and 20 age matched voluntary healthy women controls (group 1) were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a female sexual function index (FSFI) questionnaire for sexual status and the Beck Depression Inventory for psychiatric assessment. MAIN OUTCOME MEASURES: The levels of serum TSH, thyroid hormones, prolactin (PRL), free testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, lipid profile, and blood glucose were measured. RESULTS: Female sexual dysfunction (FSD) was diagnosed in 14 of 25 patients (56%) in group 4, in 6 of 11 patients (54.6%) in group 3, in 2 of 14 patients (14.6%) in group 2, and while only 3 of 20 the control group of women (15%) had FSD (P = 0.006). The mean total FSFI scores were 23.9 in the group 4, 26.03 in the group 3, 29.2 in the group 2, and 32.30 in the control group (P < 0.0001). The mean BDI score for clinic hypothyroidic patients was significantly greater than the scores for the control group and for the group 2 (P = 0.017 and P = 0.043, respectively). The mean PRL levels for patients in group 4 and group 3 were found to be significantly higher than the level for controls (P < 0.0001), whereas other serum hormone levels were not different among groups. CONCLUSIONS: A significant percent of women with clinic hypothyroidism and subclinic hypothyroidism with TSH values >10 mU/L had sexual dysfunction. Hyperprolactinemia, hyperlipidemia, and depression were associated with FSD in clinic hypothyroidism. Different than clinic hypothyroidism depression was not associated with FSD in subclinic hypothyroidism with TSH values >10 mU/L.

Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis.

Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, non-seminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery. High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dl, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatin, etoposide and bleomycin (BEP). Low-risk patients were observed. Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low-risk patients were kept on close-up. The median follow-up was 26 months (range 10-60). Of the 71 patients in high-risk group, 3 relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high-risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse. We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I non-seminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favourably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost and eliminate the compliance problems associated with intensive follow up of high-risk patients.

Serum adipocytokine levels in prostate cancer patients.

INTRODUCTION: We estimated the circulating levels of adipocytokines such as adiponectin and leptin in nonobese nondiabetic prostate cancer (PCa) patients and compared the results with controls and benign prostate hyperplasia (BPH) patients. MATERIAL AND METHODS: Fifty patients with PCa, 20 patients with BPH and 50 healthy volunteers were entered into the study. Their blood samples were investigated for adipocytokines with the ELISA method. RESULTS: Adiponectin levels were determined as 8.9 and 5.5 microg/ml for the same patients. Leptin concentration was 14.78 ng/ml in organ-confined PCa patients, and 15.24 ng/ml in advanced PCa patients. In control patients, adiponectin and leptin levels were 18.4 and 12.98 ng/ml, respectively. CONCLUSION: Serum adipocytokine levels of PCa patients were significantly different from those of controls and BPH patients who were not obese or diabetic. Therefore, further molecular investigation of these adipocytokines will help understand the mechanism.

Tissue reaction of the rat urinary bladder to synthetic mesh materials.

The aim of this study was to assess urinary bladder histopathology induced by the sling materials tension-free vaginal tape (TVT), vypro mesh, and intravaginal slingplasty (IVS). Thirty rats were studied: sham-operated controls, TVT, vypro, and IVS groups. After laparotomy, a 0.5- "e 1-cm piece of mesh was implanted on the anterior bladder wall. The bladder was examined histopathologically after 12 weeks. Inflammation, foreign-body reaction, subserosal fibrosis, necrosis, and collagen deposition were graded. The Kruskal-Wallis and posthoc Dunn tests were used. The sham-operated rats showed no tissue reactions. The TVT, vypro, and IVS groups showed increased inflammation (p = 0.006, p = 0.031, p = 0.001), subserosal fibrosis (p = 0.0001), foreign-body reaction (p = 0.0001), and collagen deposition (p = 0.0001) as compared to sham. Inflammation was more intense in the IVS group as compared to the TVT and vypro groups (p = 0.041, p = 0.028). The bladder presented more increased inflammatory response to IVS than the other meshs. This may play a role in the ultimate outcomes or complications from slings.

Ta T1 low and intermediate transitional cell carcinoma of the bladder: recurrence rates and the timing of check cystoscopies within the first year.

INTRODUCTION: The intensity of cystoscopic follow-up in the first year for patients with superficial bladder cancer has not been clearly defined. The cystoscopic follow-up of superficial bladder cancer accounts for a considerable workload for the urologist and is also an invasive procedure with high costs. We retrospectively reviewed our experience to determine any possible criteria which can lead to reduce the frequency of check cystoscopy. MATERIAL AND METHODS: A retrospective study was done on 427 patients with primary stage Ta and T1 bladder cancers treated between 1998 and 2005. The pattern of recurrence in the first year was assessed and recurrence rates calculated. RESULTS: The recurrence rate was 22% at 3 months. The recurrence rates at 6 and 9 months were 8 and 13.6% respectively. The recurrence rate at 12 months was 9.4%. For tumors with no recurrence at 3 months, the recurrence rates at 6, 9 and 12 months were 6.6, 13.4 and 8.9% respectively. With respect to stages, there was a statistically significant difference in recurrence rate stages pTa and pT1 in the first and in the third control (p = 0.001, p = 0.003) respectively. According to the recurrence rate within the first year, the difference between G1 and G2 tumors was not statistically significant regardless of the stage (p > 0.05). CONCLUSIONS: Patients with initial stage Ta or T1 grade 1 and 2 bladder cancers and negative first cystoscopy have a significantly lower recurrence rate than those with recurrence at first cystoscopy. There is a reason to change follow-up routines but in our opinion only in patients with initial low-grade carcinoma. If the third-month cystoscopy is clear, it is appropriate to perform the first check cystoscopy 1 year after initial resection.

Serum antioxidant enzyme levels are decreased in patients with urinary calcium oxalate stones.

PURPOSE: To compare the serum antioxidant enzyme levels between patients with urinary stone disease and healthy volunteers to determine the effect of cellular oxidative stress on urinary calcium oxalate stones formation.Materials & Methods: A total of 51 patients with proven urinary calcium oxalate stones (female 35.3%, mean age: 49.3 years) and 37 healthy subjects (female 45.9%, mean age: 44.1 years) were included. The serum levels of antioxidant catalase, glutathione peroxidase, superoxide dismutase and lipid peroxidation were measured in serum samples taken from the peripheral venous circulation. RESULTS: Mean serum catalase level of patient group was insignificantly higher than healthy subjects (7.54 mmol- H2O2/mg/sec versus 6.16 mmolH2O2/mg/sec, respectively; P = .06) whereas mean superoxide dismutase level (1.56 U/ml versus 3.86 U/ml, P = .047), glutathione peroxidase level (6.70 U/ml versus 8.19 U/ml, P = .022) and lipid peroxidation level (2.35 nmol/ml versus 3.31 nmol/ml, P = .034) of patient group were significantly lower than healthy subjects. Patients with family history of urinary stone disease had significantly lower mean serumlevels of catalase (P = .037), superoxide dismutase (P = .047) and glutathione peroxidase (P = .01), compared with patients without family history. CONCLUSION: The findings of this study provide evidence regarding the role of oxidative stress in the development of urinary calcium oxalate stones. Future clinical trials are necessary to elucidate the actual mechanisms of the calcium oxalate stone formation in the environment with increased oxidative stress.

Laparoscopic unroofing and aspiration-sclerotherapy in the management of symptomatic simple renal cysts.

Simple renal cysts are quite common in adults with an incidence that increases with age. Sclerosant treatment is very common, but the recurrence rate is high. Results are still under investigation for laparoscopic approaches and their long follow-up periods. Between 1998 and 2004, 21 patients were diagnosed with symptomatic renal cysts in our clinics. Initially, all patients underwent aspiration-sclerotherapy with 95% ethanol, the most common sclerosant, under ultrasound, fluoroscopy, or CT guidance. For those with sclerosant therapy failure, the laparoscopic unroofing method was used. Like open surgery, laparoscopic unroofing of the cyst appears to be effective by not only removing part of the cyst wall, but more importantly, by providing adequate drainage of the cyst. After sclerotherapy, 71% of the patients had recurrent pain and cyst on follow-up (at mean 14 months). This group of patients was cured with the laparoscopic unroofing method and there is still no recurrence. We emphasize the unroofing method as better than single session sclerotherapy. And also, laparoscopic unroofing of the cyst is more predictable and has better results than sclerotherapy aspiration.

Primary adenocarcinoma of the epididymis: case report.

Primary epididymal malignancies are uncommon and usually benign. Benign paratesticular tumors are most commonly adenomatoid, while the most common malignant paratesticular tumors are rhabdomyosarcomas. Approximately 25% of all epididymal tumors are malignant, and of the benign tumors, 60% to 78% are adenomatoid tumors. According to a recent MEDLINE search using epididymis and adenocarcinoma as key words, reports of a primary epididymal adenocarcinoma are extremely rare with only 23 cases in the literature. We report a case of epididymal adenocarcinoma with clinical follow up and metastatic natural history of this rare malignancy.

Evaluation of sexual function in women with rheumatoid arthritis.

PURPOSE: To evaluate the link between rheumatoid arthritis (RA) and female sexual functioning. MATERIAL AND METHODS: A total of 32 women with RA and 20 healthy age matched controls were enrolled in this study. The participations are asked to complete Female Sexual Function Index (FSFI), The Short form 36 (SF-36) Health Survey and Beck Depression Inventory (BDI)questionnaires. RESULTS: The groups were comparable in terms of demographic characteristics. The women with RA represented significantly worse sexual functioning in category of desire, arousal, lubrication,orgasm, satisfaction domain and total FSFI score compared with healthy women (P = .0001, P = .0001, P = .0001, P = .0001, P = .022 and P = .0001, respectively). The mean BDI scores for the patients with RA were greater than control group (P = .036). Women with RA also had significantly lower quality of life (QoL) parameters: physical functioning, limitations due to physical health, pain, general health, vitality and limitations due to emotional problems compared with healthy women (P = .0001, P = .0001, P = .028, P = .002, P = .001 and P = .0001, respectively). CONCLUSION: The present study shows that a significant percent of patients with RA had sexual dysfunction and also deterioration in QoL.

A case of seminal vesicle cyst associated with ipsilateral renal agenesis diagnosed during an investigation of urinary incontinence.

Seminal vesicle cysts are rare and usually associated with ipsilateral renal agenesis. The diagnosis of seminal vesicle cysts may be delayed or missed because of the non-specific symptoms of this condition. In this study, we aimed to discuss the diagnosis and treatment of a left seminal vesicle cyst that was associated ipsilateral agenesis in a 24-year-old patient who presented to our outpatient department with urinary incontinence. Ultrasonography and magnetic resonance imaging revealed a seminal vesicle cyst measuring 40×45 mm in diameter. Although the patient's symptoms were relieved with cyst aspiration via transrectal ultrasonography, the symptoms recurred 6 months later.

Increased expression of EZH2, a polycomb group protein, in bladder carcinoma.

INTRODUCTION: Recent experiments have demonstrated that polycomb group gene enhancer zeste homolog 2 (EZH2) is highly expressed in many cancer types. Therefore, we aim to demonstrate EZH2 gene expression in transitional cell bladder cancer. PATIENTS AND METHODS: The reverse transcriptase-polymerase chain reaction (RT-PCR) was used for detection of EZH2 mRNA levels in healthy and cancerous human bladder specimens. Also, expression of the particular protein was determined by Western blotting and immunohistochemistry to confirm RT-PCR results. RESULTS: Gradually increased expression of EZH2 was detected by mRNA and protein levels in highly advanced bladder cancer specimens. In contrast, 100% of control subjects were negative for EZH2 expression. The expression of EZH2 was more frequent in G3 (92%) than G1-G2 (62-63%) and more frequent in T1-2 (72-85%) than Ta (56%). Western blot analysis results confirm the RT-PCR results. CONCLUSIONS: EZH2 overexpression precedes high frequencies of proliferation and the gradual advance of bladder cancer. These observations suggest that deregulated expression of EZH2 is associated with bladder carcinoma.

Urodynamic findings in children with cerebral palsy.

AIM: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. METHODS: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. RESULTS: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor-sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. CONCLUSIONS: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment.

Measurement of pediatric testicular volume with Prader orchidometer: comparison of different hands.

Measurement of testicular volume is a more readily available method of estimating spermatogenesis in adolescence. Traditionally, testicular volumes have been measured with different type of orchidometers or calipers. The most widely used orchidometer is the Prader orchidometer introduced in 1966. This type of orchidometer, a graded series of ellipsoid beads on a string, is used for testicular volume measurement, which is a useful index of puberty in male in order to evaluate male growth and development. Although it is more practical and inexpensive compared with ultrasonography, this instrument has been questioned in regard to its objectiveness in different hands. We designed a prospective clinical study to investigate the correlation between testicular size measurements of three different clinical investigators by using Prader orchidometer. A total of 100 testes in 50 boys with a mean age of 6.4 years (range 1-15 years) who presented to Urology and Pediatrics outpatient clinics of our hospital without urogenital complaints were enrolled to this study. The volumes of each testis were measured independently using Prader orchidometer by three different clinical investigators (A, B and C). Each investigator repeated testicular volume measurements blinded to measurements obtained by others. The measured volumes were recorded separately. Statistical analysis of the results was performed using Pearson's correlation (r) to determine the correlation of orchidometer measurements between the examiners. All statistical analyses and power calculations were performed using computer software. Mean testicular volumes measured by three examiners A, B and C were 4.01+/-3.79 ml (SD) (2-18 ml), 3.66+/-3.46 ml (SD) (1-18 ml) and 3.86+/-3.54 ml (SD) (1-18 ml), respectively. The statistical correlation between the measurements of investigator A and B, A and C, and B and C showed a high correlation {r = 0.954 (P < 0.01), r = 0.964 (P < 0.01), and r = 0.979 (P < 0.01)}, respectively. In the present study, it was shown that testicular size measurement by using Prader orchidometer gives good correlation in different examiners' hands and it is an objective and reliable method in pediatric urological practice.

Circumcision in hemophilia: a cost-effective method using a novel device.

BACKGROUND/PURPOSE: The authors conducted a prospective clinical study to see whether the need for and the cost of factor substitution after circumcision can be reduced using a novel device for bloodless circumcision in boys with hemophilia. METHODS: Forty-five boys with hemophilia (age range, 1.5 to 25 years; median age, 11; 40 with hemophilia A, 5 with hemophilia B; weight range, 9 to 75 kg; median weight, 30 kg) were circumcised in our department between 1996 and 2001. Severity of the disease was mild in 9 cases, moderate in 11, and severe in 25. After starting systemic prophylaxis including factor substitution and DDAVP (desmopressin acetate) in reduced doses, all patients underwent circumcision under local anesthesia using a modified straight clamp and a battery-operated diathermic knife specially designed for bloodless circumcision. Duration of factor replacement ranged between 7 and 18 days, and the hospitalization period was 2 to 5 days according to severity of the disease. The last 19 patients were given tranexamic acid orally for 7 days after surgery. RESULTS: Transient minimal bleeding was observed in 5 patients and easily responded to factor administration. Moderate edema and hyperemia along the excision line owing to the diathermic effect of the device lasted for 3 to 4 days. Normal cosmetic appearance was regained within 7 to 21 days. Excellent patient and family satisfaction was reported. The average cost of the operation was calculated as 81 dollars, 144 dollars, and 243 dollars per kilogram in mild, moderate, and severe cases, respectively. CONCLUSIONS: Bloodless circumcision with "diathermic knife" is a practical and reliable alternative for boys with hemophilia. Enhancement of local hemostasis using such an alternative device may reduce the need for factor substitution and, accordingly, the cost of circumcision in hemophiliacs, down to 50%.

The etiology of erectile dysfunction and contributing factors in different age groups in Turkey.

BACKGROUND: The aim of the present study was to determine the pathophysiological factors which cause erectile dysfunction (ED), as well as the risk factors in different age groups in Turkey. METHODS: A total of 948 patients with ED who were admitted to three andrology clinics were evaluated in terms of etiological factors. They underwent a multidisciplinary diagnostic evaluation. Erectile dysfunction was classified as primarily organic, primarily psychogenic, mixed or unknown in etiology. RESULTS: Psychogenic ED was diagnosed in 65.4% of the patients and organic ED was diagnosed in 34.6% of patients overall. In patients under 40 years, the rate of psychogenic ED was 83% and the rate of organic ED was 17%, but in the patients over 40 years, the rate of psychogenic ED was 40.7% and the rate of organic ED was 59.3%. The causes of organic ED were identified as arteriogenic ED, 40.5%; cavernosal factor (venogenic) ED, 10%; neurogenic ED, 12.5%; endocrinologic ED, 1.8%; mixed type ED, 11.8%; and drug induced ED, 4.5%. CONCLUSION: Our data represent a higher ratio of ED in patients under 40, which are mostly psychogenic, This finding potentially results from local social and cultural differences.