Can low serum brain-derived neurotrophic factor levels be associated with lifelong premature ejaculation?; A pilot study.

This study aimed to present the association between the serum level of brain-derived neurotrophic factor (BDNF) and the lifelong pre-mature ejaculation (PE). The data of 40 patients with lifelong PE and 40 healthy controls were evaluated prospectively. PE diagnostic tool and patient-reported outcome measures were performed to the participants. The serum BDNF level measurement was made after the collecting of blood samples in both groups. The mean ± SD age of the PE and control group was 34.43 ± 5.71 and 33.03 ± 3.97 years respectively (p = .228). Only the participant who has been married included in the study, and there was no difference in the mean marriage duration. In both groups, smoking status, alcohol use and body mass index were similar. The median PE diagnostic tool scores were 15 (11-20), and serum BDNF levels were 225.3 (26.1-689.6) ng/ml in the PE group, 5 (0-9) and 540.9 (102.9-769.2) ng/ml in the control group respectively (p < .001 for both). The patients with PE had significantly lower serum BDNF levels. Our study suggests that lower serum BDNF levels may be directly related to lifelong PE.

Preoperative neutrophil-to-lymphocyte ratio as a new prognostic predictor after microsurgical subinguinal varicocelectomy.

Various studies have been reported to predict the success of varicocelectomy. Neutrophil-lymphocyte ratio (NLR) is a frequently used indicator of systemic inflammation. We aimed to evaluate the effect of inflammation on the success of varicocelectomy using the NLR. The data of 86 patients who underwent varicocelectomy for infertility were evaluated retrospectively. Pre-operative demographic characteristics of patients, laboratory results such as haemogram, and semen analysis and clinical data were recorded. The semen analysis with the highest total motile sperm count was accepted as pre-operative value. Control was performed with semen analysis at post-operative 6th month. As described in previous studies, in our study, more than 50% increase in total motile sperm count in post-operative semen analysis was defined as a significant improvement. However, at least a 100% increase was required for patients with a total motile sperm count <5 million in the definition of recovery. Patients were divided into two groups as those with improvement in the semen parameters (Group 1) and those without (Group 2). NLR was statistically significantly higher in Group 2 compared with Group 1. The area under the curve (AUC) in the ROC curve for NLR was 0.89. According to the Youden index, the best cut-off value of NLR for varicocelectomy success was 1.98 (sensitivity: 94.7%, specificity: 75.9%, p < 0.001). Logistic regression analysis showed that NLR (odds ratio: 3.6, 95% confidence interval: 1.69-8.38, p < 0.001) is independent predictor factors in predicting the success of varicocelectomy. The results of this study show that systemic inflammation adversely affects the likelihood of improvement in sperm parameters by varicocelectomy. Additionally, NLR has been shown to be an independent factor in the prediction of varicocelectomy success.

Effect of the Oxidant-Antioxidant System in Seminal Plasma on Varicocele and Idiopathic Infertility in Male Humans.

BACKGROUND: The aim of this study was to investigate seminal oxidant-antioxidant activity in idiopathic and varicocele infertility in men. METHODS: Total anti-oxidant capacity (TAC), total oxidant status (TOS), paraoxonase (PON1), aryl esterase (ARE), and total thiol levels (TTL) were measured in seminal plasma with an autoanalyzer. The TOS/TAC ratio was determined as the oxidative stress index (OSI). A histopathological evaluation of the sperm was performed in the andrology laboratory of the hospital. Number, motility, morphology, volume, pH, and leukocytes were evaluated in all samples according to World Health Organization criteria. The three study groups were as follows: G1, males with idiopathic infertility; G2, males with varicocele infertility; and G3, normal healthy males (had fathered a child in the last 2 years). Each group was composed of 36 men (age, 25 - 40 years). The Rel Assay Diagnostics kit was used to determine the levels of the parameters. The study was conducted according to the principles of the declaration of Helsinki and was approved by Sakarya University Medicine Faculty Ethic Committee (e.n: 16214662/050.01.04/07). Statistical significance was assumed if p < 0.05. All statistical evaluations were performed using SPSS (version 20.0 for Windows; SPSS, Inc., Chicago, IL, USA). RESULTS: No differences were detected between the mean values of antioxidant parameters among the three groups (Kruskal-Wallis test). The p-values of the test parameters (TAC, TOS, PON1, ARE, TTL, OSI) are respectively: 0.494, 0.548, 0.068, 0.151, 0.202, 0.873. The antioxidant parameters of all subjects were compared using the MannWhitney U-test in both groups as fertile (G3) and infertile (G1 + G2). The PON1 levels in infertile subjects were significantly higher than those in fertile subjects. There was a statistically significant difference (p = 0.042). The other antioxidant parameters had no statistically significant difference (p > 0.05). The ARE was not performed in group 3 (control) due to a methodological problem. CONCLUSIONS: PON1 levels in infertile subjects were significantly higher than those of fertile subjects.

Can neutrophil to lymphocyte ratio predict lamina propria invasion in patients with non muscle invasive bladder cancer?

OBJECTIVE: Recent studies have demonstrated the role of systemic inflammation in the development and progression of cancer. In this study, we evaluated whether preoperatively measured neutrophil-to-lymphocyte ratio (NLR) can predict lamina propria invasion in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS: We reviewed the medical records of 304 consecutive and newly diagnosed patients with bladder cancer who had been treated with transurethral resection between January 2008 and June 2014. In total, 271 patients were included in the study and the patients were divided into two groups according to the pathological stage (Group 1: Ta, Group 2: T1). NLR was calculated by dividing the absolute neutrophil count (N) by the absolute lymphocyte count (L). RESULTS: In total, 271 patients (27 women and 244 men) were enrolled. Mean age was higher in Group 2 than in Group 1 (67.3±10.8 vs. 62.9±10.8, p<0.001). Furthermore, the presence of high grade tumors and tumors ≥3cm in size was statistically higher in Group 2 than in Group 1 (70.9% vs. 9.9%, p=0.0001; 71.8% vs. 36%, p=0.0001, respectively). While the mean white blood cell (WBC) and N counts were statistically insignificant (7.63±1.87 vs. 7.69±1.93, p=0.780; 4.72±1.54 vs. 4.46±1.38, p=0.140; respectively), L was significantly lower and NLR was significantly higher in Group 2 than in Group 1 (2.07±0.75 vs. 2.4±0.87, p=0.001; 2.62±1.5 vs. 2.19±1.62, p=0.029; respectively). CONCLUSION: Our data indicate that high NLR and low L are statistically associated with T1 stage, whereas low L are able to predict lamina propria invasion in patients with NMIBC. These findings suggest that pretreatment measurement of NLR may provide valuable information for the clinical management of patients with NMIBC. Prospective studies are now required to further validate the role of NLR as a risk factor in NMIBC.

Pilates for Better Sex: Changes in Sexual Functioning in Healthy Turkish Women After Pilates Exercise.

Although a large number of studies report the impact of daily exercise on many aspects of women's health, none of them address the relationship between Pilates exercise and sexual function prospectively. The aim of this study was to assess the effect of Pilates exercise on sexual function in healthy young women using a validated questionnaire. In total, 34 premenopausal healthy Turkish women aged between 20 and 50 years who had regular menstrual cycles and sexual relationships were included in the study. Women were asked to complete Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. Questionnaires were completed before and after 12 weeks of Pilates exercise. Primary endpoints were changes in total and individual domain scores on the FSFI and BDI. After the 12-week Pilates intervention, BDI scores were decreased and all domains of the FSFI were significantly improved with mean ± SD total FSFI scores increasing from 25.9 ± 7.4 to 32.2 ± 3.6 (p <.0001). This is the first prospective study that quantifies the improvement in sexual function of healthy women after a 12-week Pilates program. Our findings suggest that Pilates may improve sexual function in healthy women. However, further studies with a larger sample size are needed in this field.

Adipose Tissue-Derived Stem Cells for the Treatment of Erectile Dysfunction.

Although a spectrum of options is available for erectile dysfunction (ED) treatment, ED in diabetics, post-prostatectomy patients, and those with Peyronie's disease (PD) may be more severe in degree and less likely to respond to conventional medical therapies. Unfortunately, there have been limited breakthroughs in therapeutic options for severe ED during the past decade. However, one of the more fascinating strategies in preclinical development to treat ED is stem cell transplantation. Depending on the cell type, recent research has demonstrated that with transplantation, these stem cells can exert a paracrine effect on surrounding penile tissues and differentiate into smooth muscle, endothelium, and neurons. Adipose tissue-derived stem cells (ADSCs) have become a valuable resource because of their abundance and ease of isolation. It is evident that ADSCs may provide a realistic, therapeutic modality for the treatment of ED. In this review, we will cover the literature that has evaluated ADSCs in the treatment of ED.

The relationship between histological prostatitis and lower urinary tract symptoms and sexual function.

This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Transforming Growth Factor-ß1 Induced Urethral Fibrosis in a Rat Model.

PURPOSE: We sought to develop a reproducible TGF-ß1 injection technique to induce urethral fibrosis in the rat urethra. MATERIALS AND METHODS: A total of 32 male Sprague Dawley® rats weighing 300 to 350 gm were anesthetized with ketamine/xylazine intraperitoneally. Using a 5 mm penoscrotal incision the rat urethra was exposed. In the experimental group varying doses of TGF-ß1 (5, 10 and 25 µg) were injected in each side of the urethral wall. Normal saline infiltration was used in the sham treated group. Rats were sacrificed 2 and 4 weeks following TGF-ß1 injection. Urethral specimens were stained with hematoxylin and eosin, and Masson trichrome, and Western blot evaluations were performed. Normal and strictured urethral tissues from patients were collected and evaluated in the same fashion. RESULTS: There was no evidence of urethral wall thickening or fibrosis in the sham treated group. Varied histological evidence of fibrosis was noted in all experimental groups. There was a significant increase in collagen type I expression 2 weeks after injection of 5, 10 and 25 µg TGF-ß1. Collagen type III expression was significantly increased 2 weeks after injecting 10 and 25 µg of TGF-ß1, which persisted to 28 days after injection. CONCLUSIONS: TGF-ß1 injection can successfully generate a reproducible rat model of urethral spongiofibrosis. This technique is simple, inexpensive and reproducible. Our series is a proof of concept study. Additional studies in larger animals are needed to further confirm our findings.

Intratunical Injection of Genetically Modified Adipose Tissue-Derived Stem Cells with Human Interferon α-2b for Treatment of Erectile Dysfunction in a Rat Model of Tunica Albugineal Fibrosis.

INTRODUCTION: Peyronie's disease (PD) has frequently been associated with erectile dysfunction (ED) and may further compromise coitus. AIM: To investigate the efficacy of intratunical injection of genetically modified rat adipose tissue-derived stem cells (ADSCs) expressing human interferon α-2b (ADSCs-IFN) in decreasing fibrosis and restoring erectile function in a rat model of tunica albugineal fibrosis (TAF). METHODS: A total of 36 Sprague-Dawley rats (12 weeks old; 300-350 g) were randomly divided in six equal groups: (i) sham group (50 µL saline-injected into the tunica albuginea [TA]); (ii) TAF group (transforming growth factor [TGF]-ß1 [0.5 µg/50 µL] injected into the TA); (iii) TGF-ß1 plus 5 × 10(5) control ADSCs injected same day; (iv) TGF-ß1 plus 5 × 10(5) ADSCs-IFN injected same day; (v) TGF-ß1 plus 5 × 10(5) control ADSCs injected after 30 days; and (vi) TGF-ß1 plus 5 × 10(5) ADSCs-IFN injected after 30 days. Rat allogeneic ADSCs were harvested from inguinal fat tissue. MAIN OUTCOME MEASURES: Forty-five days following the TGF-ß1 injection, erectile function was assessed, and penile tissues were harvested for further evaluations. RESULTS: In the same-day injection groups, intratunical injection of ADSCs and ADSC-IFN improved erectile response observed upon stimulation of cavernous nerve compared with TAF group. Intratunical ADSC-IFN injection at day 30 improved erectile responses 3.1, 1.8, and 1.3 fold at voltages of 2.5, 5.0, and 7.0, respectively, when compared with TAF group. Furthermore, at voltages of 2.5 and 5.0, treatment on day 30 with ADSCs-IFN improved erectile responses 1.6- and 1.3-fold over treatment with ADSCs alone. Local injection of ADSCs or ADSCs-IFN reduced Peyronie's-like manifestations, and these effects might be associated with a decrease in the expression of tissue inhibitors of metalloproteinases. CONCLUSION: This study documents that transplantation of genetically modified ADSCs, with or without human IFN α-2b, attenuated Peyronie's-like changes and enhanced erectile function in a rat model of TAF.

Childhood enuresis is associated with shorter intravaginal ejaculatory latency time in healthy men.

PURPOSE: In our previous study we showed that there was a significant increase in the prevalence of monosymptomatic enuresis among lifelong premature ejaculators. In this study we compared the intravaginal ejaculatory latency time of men with and without a history of monosymptomatic enuresis, and determined the association between the severity and duration of monosymptomatic enuresis and intravaginal ejaculatory latency time in healthy men. MATERIALS AND METHODS: Between March and September 2012 we designed a prospective study in 49 healthy men who had a history of monosymptomatic enuresis and in age matched 49 control cases without a history of monosymptomatic enuresis. All subjects were asked about their history of monosymptomatic enuresis. Each subject was then evaluated using the premature ejaculation diagnostic tool and asked to measure their intravaginal ejaculatory latency times with their female sexual partner using a calibrated stopwatch. RESULTS: Men with a history of monosymptomatic enuresis and control cases had a mean age of 33.6 (SD 4.7, range 25 to 43) and 33.8 (SD 5.4, range 25 to 48) years, respectively (p = 0.97). Mean/median intravaginal ejaculatory latency times of men with and without a history of monosymptomatic enuresis were 196.9/126.2 and 426.6/343.2 seconds, respectively (p <0.001). Mean/median premature ejaculation diagnostic tool scores of men with and without a history of monosymptomatic enuresis were 7.1/6 and 2.3/2, respectively (p <0.001). In correlation matrix analysis, intravaginal ejaculatory latency times and premature ejaculation diagnostic tool scores were correlated significantly with monosymptomatic enuresis history, duration and severity (p <0.001). CONCLUSIONS: We found that intravaginal ejaculatory latency time in men with a history of monosymptomatic enuresis is significantly shorter than that of controls. We have also shown that there is a strong negative correlation between having a history of monosymptomatic enuresis and intravaginal ejaculatory latency time.

Androgen deprivation therapy impact on quality of life and cardiovascular health, monitoring therapeutic replacement.

INTRODUCTION: Androgen deprivation therapy (ADT) is commonly utilized in the management of both localized and advanced adenocarcinoma of the prostate. The use of ADT is associated with several adverse events, physical changes, and development of medical comorbidities/mortality. AIM: The current article reviews known adverse events associated with ADT as well as treatment options, where available. Current recommendations and guidelines are cited for ongoing monitoring of patients receiving ADT. METHODS: A PubMed search of topics relating to ADT and adverse outcomes was performed, with select articles highlighted and reviewed based on level of evidence and overall contribution. MAIN OUTCOME MEASURES: Reported outcomes of studies detailing adverse effects of ADT were reviewed and discussed. Where available, randomized trials and meta-analyses were reported. RESULTS: ADT may result in several adverse events including decreased libido, erectile dysfunction, vasomotor symptoms, cognitive, psychological and quality of life impairments, weight gain, sarcopenia, increased adiposity, gynecomastia, reduced penile/testicular size, hair changes, periodontal disease, osteoporosis, increased fracture risk, diabetes and insulin resistance, hyperlipidemia, and anemia. The definitive impact of ADT on lipid profiles, cardiovascular morbidity/mortality, and all-cause mortality is currently unknown with available data. Treatment options to reduce ADT-related adverse events include changing to an intermittent treatment schedule, biophysical therapy, counseling, and pharmacotherapy. CONCLUSIONS: Patients treated with ADT are at increased risk of several adverse events and should be routinely monitored for the development of potentially significant morbidity/mortality. Where appropriate, physicians should reduce known risk factors and counsel patients as to known risks and benefits of therapy.

Beneficial effects of Pilates exercise on female sexual dysfunction: A prospective pilot study.

OBJECTIVE: Female sexual dysfunction (FSD) is a significant public health issue, and it has a high global prevalence. Few effective treatment options are available for the treatment of FSD. We conducted a prospective clinical pilot study to investigate the beneficial effects of Pilates exercise on sexual function in women with FSD. METHODS: Women aged between 20 and 50 years and who had regular menstrual cycles and sexual relationships and participating Pilates exercise program were asked to complete Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires before starting the Pilates exercise program. If the total FSFI score was less than 26.55, which is the cut-off for FSD, the subject was invited to participate in the study. Primary endpoints were changes in total and individual domain scores on the FSFI and BDI. RESULTS: A total of 36 premenopausal women were included in the study. After a 12-week Pilates program, all domains of the FSFI were significantly improved, with mean±SD total FSFI scores increasing from 12.0±4.9 to 29.3±3.4 (P<0.0001). BDI scores were significantly decreased from 25.1±14.3 to 1.6±3.7 (P<0.0001) after the exercise program. CONCLUSIONS: This pilot study showed that Pilates exercise could improve sexual functions in women with FSD. Pilates may facilitate the treatment of sexual dysfunction in women.

Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up.

INTRODUCTION: Penile implant surgery continues to be an important option for men with erectile dysfunction. Advancements in technology of implants have contributed to improved survival from mechanical breakdown. Prosthesis infection remains a serious adverse event. For the last 8 years, the Titan implant (Coloplast Corporation, Minneapolis, MN, USA) has been available with an infection-retardant polyvinylpyrrolidone coating. AIM: To compare the infection rates between coated three-piece inflatable penile prostheses (IPPs) with the previous non-coated model. MAIN OUTCOME MEASURES: Infection-related revisions reported in the physician-generated, manufacturer-tabulated patient information forms (PIFs). METHODS: PIFs reported into the voluntary, post-market registry of Coloplast Corporation from July 14, 2000 to September 30, 2011 were retrospectively reviewed. Infection-related revisions entered into the product evaluation database for coated and non-coated IPPs were compared. Data were analyzed using Pearson's chi-squared test. RESULTS: The database included 36,391 PIFs related to primary IPP implantation. At 11 years of follow-up, 4.6% (7,031) of non-coated IPPs were removed or replaced due to infections, whereas 1.4% (29,360) of hydrophilic-coated implants reported replacements due to device infections. The hydrophilic coating of the IPP components makes the device slippery and prevents bacterial attachment. The hydrophilic coating allows rapid absorption of antibiotics in an aqueous solution and allows these water-soluble antibiotics to elute off the device into the implant spaces. Unfortunately, information pertaining to what agents were used in the studies patients was not tabulated. The rate of revision due to device infection was reduced 69.56% in patients with hydrophilic-coated IPPs (P<0.001). CONCLUSION: To the best of our knowledge, this is the longest post-marketing registry report related to IPP infections. At 8 years of follow-up, the hydrophilic-coated IPPs demonstrated a significant reduction in revision rates due to infection when compared with the 11-year follow-up of non-coated implants. Since there was no information or uniformity of antibiotics used in the soaking solution, it is uncertain which antibiotic selection provided the best results. In vitro testing against known infectious agents may further benefit IPP patients by reducing the prosthesis infection rate.

Metastatic prostate adenocarcinoma presenting as supraclavicular lymphadenopathy: a report of two cases.

Clinical examination is very important in the practice of medicine. In patients presenting with a supraclavicular mass, a number of diseases including cancer should be ruled out. Two patients who presented with a bulky left supraclavicular mass were evaluated. Their medical history revealed complaints attributed to lower urinary tract infection. We performed histopathological examination of the lymph nodes with radiological evaluation of the thorax and abdomen. The final diagnoses were prostate cancer in both patients. It should always be kept in mind that prostate cancer is the most frequent cancer in elderly men, and although very unusual, the presenting finding can be cervical or supraclavicular lymphadenopathy; thus clinicians should be aware of urological examinations in such cases.

The effects of phosphodiesterase type 5 inhibitors on penile rigidity variables during a period with no sexual stimulation: a laboratory setting double-blind study.

OBJECTIVE: To investigate the effects of phosphodiesterase type 5 (PDE5) inhibitors on erectile variables during a period with no sexual stimulation in a laboratory setting double-blind study. PATIENTS AND METHODS: In all, 80 men without erectile dysfunction (ED) but with lifelong premature ejaculation (PE) were included in the study. The men were divided equally in to four groups and received either placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. The men attended the laboratory following 3 days of sexual abstinence and placebo or one of the PDE5 inhibitors was ingested after ≥ 2 h of fasting and non-smoking. The men were then immediately placed in a silent room and real-time penile rigidity and tumescence monitoring with Rigiscan Plus (Rigiscan Plus® System, Osbon Medical Systems, Augusta, GA, USA) began. The men read some magazines or newspapers that contained no sexually stimulating material for 1.5 h. There was no interaction between the men and observer during the test period. Times to first measured and total durations of base and tip rigidities, and also total and per minute rigidity were evaluated. RESULTS: The recorded base and/or tip rigidity ratios were 40% (eight of 20), 71% (12/17), 47% (nine of 19) and 70% (14/20) in men who took placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.126). The ratio of men who could obtain ≥ 60% base and/or tip rigidities were 10% (two of 20), 41% (seven of 17), 26% (five of 19) and 55% (11/20) in placebo, sildenafil, tadalafil and vardenafil groups, respectively (P < 0.05). The median time to first measured base rigidity was 58.0, 21.5, 54.5 and 57 min with placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0032). The median total duration of recorded base rigidity was 4.0, 27.5, 10.0 and 11.5 min in men who took placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.013). The median total base rigidity (area under the curve) was 72.8, 699.0, 360.5 and 553.0 with placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.016). CONCLUSIONS: Significant penile rigidities were obtained with PDE5 inhibitors during the short test period, with no sexual stimulation, in laboratory conditions. This finding might support the use of PDE5 inhibitors in men who need penile rehabilitation.

The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double-blind laboratory setting study.

UNLABELLED: Study Type--Therapy (RCT) Level of Evidence 1b. What's known on the subject? and What does the study add? Several authors have reported their experience with PDE5 inhibitors alone or in combination with selective serotonin re-uptake inhibitors for treating premature ejaculation. However, to our knowledge, this is the first laboratory design study to evaluate the effects of three PDE5 inhibitors throughout the ejaculation process in men with lifelong premature ejaculation. In this laboratory setting study PDE5 inhibitors seem to prolong ELT but the difference from placebo is significant only in vardenafil. The quality of penile rigidity is better with PDE5 inhibitors in the post-ejaculatory period but the difference is significant only in sildenafil and vardenafil. OBJECTIVE: • To evaluate the effects of three phosphodiesterase type 5 (PDE5) inhibitors on the ejaculation process in men with lifelong premature ejaculation using a double-blind laboratory setting. PATIENTS AND METHODS: • Eighty men with lifelong premature ejaculation, 20 in each group, received placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. Placebo or PDE5 inhibitor was ingested after at least 2 h fasting and non-smoking. The subjects were placed in a silent room immediately and real-time penile rigidity and tumescence was monitored. • Subjects read some magazines or newspapers without any sexually stimulating material for 1.5 h. At the end of this period audiovisual sexual stimulation began with a video film and after the 8th minute the subject began vibratory stimulation to the frenular area. • At the beginning of ejaculation the patient stopped stimulation. When the patient began and stopped stimulation, the light near the observer turned on and off and the observer calculated the ejaculation period with a chronometer. The elapsed time was the ejaculation latency time (ELT) in seconds. • There was no interaction between subjects and observer during the test. The ELT, and the qualities of base and tip rigidities during ELT and after ejaculation were calculated. RESULTS: • Median age of patients was 29 (range 22-39) years and median duration of premature ejaculation was 60 (range 7-180) months and there was no significant difference between groups. Median duration of vibratory stimulation (ELT) of subjects who received placebo was 48.5 s: 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil. Compared with the placebo group, ELT was significantly longer only in subjects receiving vardenafil (P = 0.019). • In the post-ejaculatory refractory period, times to last recorded base rigidities were significantly longer than placebo in vardenafil and sildenafil groups with better erection quality (P < 0.01 for each). CONCLUSIONS: • The PDE5 inhibitors seem to prolong ELT and the quality of penile rigidity is better with PDE5 inhibitors in post-ejaculatory period. • These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.

Effect of Thymoquinone on Oxidative Stress in Escherichia coli-Induced Pyelonephritis in Rats.

BACKGROUND: Recurrent urinary tract infections are important in children and adults with diabetes mellitus and/or incontinence due to risk of pyelonephritis (PYN) and renal damage. There is a positive correlation released free radicals during PYN and renal damage. Experimental studies showed that antioxidant agents improve renal damage when used immediately after bacterial inoculation. OBJECTIVE: The aim of the present study was to evaluate whether treatment by thymoquinone (TQ) before or during Escherichia coli inoculation prevents oxidative damage in acute pyelonephritis (PYN) in an ascending obstructive rat model. METHODS: In this study, 42 Wistar rats were grouped as follows: control, PYN (24, 48, and 72 hours), and TQ-PYN (24, 48, and 72 hours). E. coli (1 ×10(9) colony forming units) was inoculated into the bladder via urethral catheterization in both the PYN and TQ groups. TQ injections were performed 24 hours before bacteria inoculation and repeated at 24-hour intervals during the indicated time at a dose of 10 mg/kg body weight intraperitoneally in TQ groups. RESULTS: Superoxide dismutase activity was statistically lower in the TQ-PYN-48 and -72 groups than the PYN-48 and -72 groups (P < 0.001, P = 0.004, respectively). Catalase activity was significantly higher in PYN-24, -48, and -72 groups than the control group (P < 0.001). In addition, there was a significant difference between the TQ-PYN-24, -48, and -72 groups and PYN groups in terms of glutathione peroxidase activity (P < 0.001, P = 0.026, P = 0.046, respectively). When the TQ-PYN-72 group was compared with the PYN-72 group, malondialdehyde levels were significantly lower in the TQ-PYN-72 group than in the PYN-72 group (P = 0.033). A histologic examination also confirmed the protective effect of TQ. In statistical analysis of histopathologic findings, there were significant differences between the PYN-24 and TQ-PYN-24, PYN-48 and TQ-PYN-48, and PYN-72 and TQ-PYN-72 groups (P = 0.008, P < 0.001, P < 0.001, respectively). CONCLUSIONS: The results indicate that TQ administration attenuated the oxidative damage that occurred in PYN and, therefore, could be used as a supportive agent to protect the kidneys from oxidative damage caused by PYN.

Epidural blockade for alternative management of priapism: A case report of child with T-cell acute lymphoblastic leukemia.

Priapism is a clinical condition that rarely presents with leukemia in childhood. Management of priapism treatment can become more complex and difficult when accompanied by acute leukemia. We presented a 16 years old child with t-cell acute lymphoblastic leukemia (ALL) who developed priapism. Due to the failure of conservative methods and intracavernosal drainage, we performed epidural blockade which has limited data reported with successful results in the literature before shunt surgery.