Comorbidity of the congenital absence of the vas deferens.

Congenital absence of the vas deferens (CAVD) is a relatively rare anomaly that may contribute to male infertility. The aim of this study was to evaluate the clinical features of patients with CAVD and to emphasise some pathological conditions that may be detected during the infertility work-up or follow-up of these patients. The charts of 150 males with the diagnosis of CAVD were evaluated retrospectively. The demographic characteristics, reasons for attendance, the way of diagnosis, interventions for infertility before and after attendance, physical examination findings, reproductive hormone levels, semen analysis results, genetical analysis results and resultant live birth events were all included in the study. There were 101 bilateral and 43 unilateral CAVD cases. Thirty-two males (30.2%) had some renal abnormalities. Two cases, one with bilateral and one with unilateral agenesis, died because of colon cancer at a young age. One case with CUAVD had acute lymphoblastic leukaemia. Congenital absence of the vas deferens should not be seen only as a fertility problem because of the many genotypic or phenotypic disorders that may be present with it. These disorders can cause serious general health problems either presently or in future and can also be transmitted to future generations.

Three cases of Klinefelter's syndrome with unilateral absence of vas deferens.

Genital abnormalities such as congenital uni/bilateral absence of the vas deferens are very rare in Klinefelter's syndrome. Here, we report three cases of Klinefelter's syndrome with unilateral absence of the vas deferens. All cases had small testicles, and unilateral vas deferentia were not palpable. Hormonal evaluations revealed hypergonadotropism. One case had elevated prolactin level, and pituitary adenoma was detected by magnetic resonance imaging. All cases were diagnosed as Klinefelter's syndrome (one of them had mosaicism) cytogenetically, and some CFTR gene mutations were detected. To our knowledge, this is the first case series of both conditions existing simultaneously.

Comparison of FDG and FDG-labeled leukocytes PET/CT in diagnosis of infection.

UNLABELLED: The aim of this study is to compare FDG and FDG-labeled leukocyte (WBC) PET/CT in the diagnosis of infection using different SUV and visual thresholds for interpretation. Patients, material, method: 49 consecutive patients (27 men, 22 women, mean age: 55.7 years, range: 16-89 years) with suspected musculoskeletal infection (n = 34), vascular graft infection (n = 5), aortitis (n =1 ), endocarditis (n = 1), mass lesion which is suspicious for infection or malignity (n = 6), and fever of unknown origin (n = 2) underwent both FDG and WBC-PET/CT. Images were evaluated by both visual analysis (grade 1-3) according to uptake intensity and quantitative grading (grade 1-3) based on lesion to background SUVmax values. Final diagnosis was made by histopathological, microbiological analysis or clinical-radiological work-up. RESULTS: The diagnosis of infection was made in total 24 patients, of whom 14 were diagnosed by histopathological and the rest by clinical-radiological work-up. WBC-PET/CT imaging with the visual threshold of 1b as infection positivity (for truncal lesions uptake equivalent to liver or lumbar vertebrae uptake; for extremity lesions uptake significantly higher than neighbouring soft tissue uptake or higher than neighbouring bone marrow uptake) was found to have the highest diagnostic accuracy (AUC: 0.874, CI: 0.771-0.997, p < 0.001). The optimal SUV threshold was found to be 8.8 (p = 0.006; sensitivity: 72.7%, specificity: 82.8) and 5.3 (p < 0.001; sensitivity: 81.8%, specificity: 79.3%) for FDG and WBC-PET/CT, respectively by ROC curve analysis. CONCLUSION: WBC-PET/CT is more valuable than FDG PET/CT in the imaging of infection. Visual threshold of >1b seems to be more suitable for detection of infection.

Prevalence of male pelvic dysfunction: results from the Turkish society of andrology male sexual health study group.

The objective of this study was to determine the prevalence of male pelvic dysfunction (MPD) and its correlation in men ≥40 years of age in a population-based study. This study was designed as a non-interventional, observational, cross-sectional field survey. Participating males of ≥40 years were randomly selected from 19 provinces of Turkey. All participants were asked to complete a survey including data regarding demographics, socio-economic status, socio-cultural factors, medical and sexual history, current medications, comorbidities and three validated questionnaires assessing lower urinary tract symptoms (International Prostate Symptom Score), erectile dysfunction (International Index of Erectile Function) and ejaculatory behaviour (Male Sexual Health Questionnaire-4). MPD was defined by combining abnormal scores calculated from all three questionnaires. All data were analysed statistically and p < 0.05 was accepted as significant. A total of 2730 males of ≥40 years (mean, 54.2 ± 10.6 years) were enrolled in this study. The prevalence of MPD was calculated as 24.4% among all participants. The prevalence of MPD was lowest at age between 40 and 49 years (9.1%) and highest at ≥70 years (76.6%), exhibiting correlation with age. Each decade of increase in age was associated with a 3.4-fold increase in presence of MPD. At logistic regression analyses; age, diabetes, hypertension, dyslipidemia, cardiovascular disease, obesity and lower income were found to be independent predictors for increased prevalence of MPD. This study reports prevalence of MPD as 24.4% in males of ≥40 years. Furthermore, age was found to be the main independent predictor of having MPD.

Association of left varicocoele with height, body mass index and sperm counts in infertile men.

The aim of this study was to evaluate interrelation of left varicocoele with height, body mass index (BMI) and sperm counts. We retrospectively evaluated the data of all patients who consulted for infertility at a tertiary academic referral centre from 2000 to 2010. Patient's height, weight, BMI, semen analysis, presence or absence of varicocoele and varicocoele side and grade were evaluated. In statistical evaluations chi-square, student's t, Mann-Whitney U, anova and logistic regression analyses were performed. In anova analyses, Bonferroni post hoc test was performed when needed. The data of 1842 among 2780 men, presenting for infertility, were included in the study. There were 587 men (31.9%) with left varicocoele and 1255 (68.1%) men without varicocoele. Two hundred and seventy-two men (14.8%) had grade I or II, and 315 men (17.1%) had grade III varicocoeles. Mean height was 174.3 ± 6.7 and 172.5 ± 7.0 cm in men with and without varicocoele respectively (p < 0.001). The mean BMI of cases without varicocoeles (25.8 kg/m(2) ) was greater than varicocoele group (24.9 kg/m(2) ) (p < 0.001). Percentage of varicocoele was the highest in moderately oligozoospermic males and significantly higher than the men with normal sperm count. As the height increased, the probability of having varicocoele increased, and the inverse is true for BMI. If varicocoeles are a progressive lesion, perhaps taller men with varicocoeles should be followed more closely to evaluate their fertility and androgenic status.

Insight on pathogenesis of lifelong premature ejaculation: inverse relationship between lifelong premature ejaculation and obesity.

Although both biological and psychological factors are important in the etiology, the exact pathogenesis of lifelong premature ejaculation (PE) remains to be clarified. Obesity is a worldwide epidemic that contributes to many chronic diseases. Obesity is associated with erectile dysfunction, but the relationship between obesity and PE has not yet been specifically investigated. The aim of this study was to evaluate the relationships of these two conditions. Between January 2008 and December 2009, we evaluated consecutive patients with lifelong PE in the urology outpatient clinic. Control cases without lifelong PE were selected randomly among cases attending the department of internal medicine for a checkup procedure. The age and sex of control group were matched with that of the study group. Body mass index (BMI) of each case was calculated using the World Health Organization criteria by the measurements of the physician instead of relying on verbal expressions. The mean (+/-s.d.) age of the premature ejaculators was 31.7+/-5.7 (range 21-51) years and in the control cases it was 32.3+/-6.7 (range 22-54) years. The comparison of the mean (+/-s.d.) weight between the study (74.1+/-11.2 kg) and control groups (81.9+/-6.4 kg) revealed a significant difference (P<0.001). The mean BMI of premature ejaculators (24.9+/-3.4 kg m(-2)) was lower than the mean BMI of control (27.5+/-3.6 kg m(-2); P<0.001). As the BMI increased, the number of patients decreased in the PE group. The number of the obese cases in the control group (n=26, 24.1%) was three times greater than the obese premature ejaculators (P<0.005), and the number of PE patients were approximately two times greater than the control cases in the normal-weight class (P<0.001). This is the first prospective study that investigated the relationship between lifelong PE and obesity, and we found that patients with lifelong PE were leaner than the healthy control cases.

Color Doppler ultrasonography findings of bladder tumors: correlation with stage and histopathologic grade.

PURPOSE: To describe color Doppler ultrasonography findings of bladder tumors and to investigate the correlation between these findings with stage and histopathological grade. MATERIAL AND METHODS: Twenty-four patients with bladder tumors were assessed with color Doppler ultrasonography for tumor size, presence of vascularity, vascular pattern, and spectral properties. All patients underwent surgery. Stage and histopathological grades of tumors were determined and compared with color Doppler ultrasonography findings. RESULTS: Presence of vascularity was related to tumor size (P<0.05) and color Doppler signal was detected when tumors reached 24 mm in size. There was no statistically significant relationship between tumor stage and histopathological grade with tumor size, presence and pattern of vascularity, and spectral color Doppler ultrasonography findings (P>0.05). CONCLUSION: The evaluation of vascularity in bladder tumors by color Doppler ultrasonography is not helpful in predicting tumor stage and histopathological grade before surgery.

The laparoscopic stylet.

A new instrument, laparoscopic stylet, developed for the laparoscopic extraction of the ureteral and renal pelvis calculi is described. The laparoscopic stylet is made of chromium nickel as a modification of the classical stylet. Until now, this instrument has been used in 11 retroperitoneoscopic ureterolithotomy operation and found to be quite useful for the mobilisation and extraction of the calculi from the ureters, suggesting its probable use also in the laparoscopic pyelolithotomy procedures.

The relationship between the duration of menopause and lower urinary tract symptoms in women aged 40 to 59.

OBJECTIVE: To evaluate lower urinary tract symptoms in pre- and perimenopausal women. METHOD: Four hundred seventy-one women between 40 and 59 years of age with perimenopausal complaints attending our menopause clinic were evaluated for lower urinary tract symptoms by using the International Prostate Symptom Score questionnaire. The women were categorized by subgroups as being in premenopause, early menopause (1-<5 years' duration) and late menopause (> or = 5 years' duration), and by decade. Statistical evaluations were done by unpaired t test, one-way ANOVA, and simple and multiple regression analyses. RESULTS: The premenopausal women in their forties had more severe lower urinary tract symptoms when compared with early and late menopausal women. In comparisons the nocturia score tended to rise with age. CONCLUSION: Lower urinary tract symptoms appear to be affected by both age and the duration of menopause in women in their forties and fifties, and this observation might be taken into consideration while evaluating this age group for lower urinary tract symptoms.

Does pleurodesis for pleural effusions give bright ideas about the agents for hydrocele sclerotherapy?

OBJECTIVE: Evaluation of the effectiveness of rifampicin and some agents used in the pleurodesis of pleural effusions, such as autologous blood and purified mineral talc. PATIENTS AND METHODS: A total of 56 hydroceles were treated by sclerotherapy, in a random fashion, using purified mineral talc, rifampicin and autologous blood as sclerosant agents. The control group of patients were handled with aspiration only. RESULTS: The cohort of patients in the blood group had a success rate comparable to the control group (p > 0.05). the rifampicin group did better than both control and blood groups (p < 0.05) but not better than the talc group (p < 0.01). Success rate was highest in the talc group of patients who needed no re-sclerotherapy procedures. CONCLUSION: Purified mineral talc was shown to be potentially the best sclerosant for the sclerotherapy of hydroceles and epididymal cysts.

The menopause and bladder weight.

The aim of the study was to determine, whether bladder weight changes in the menopause and whether there is any correlation between lower urinary tract symptoms and bladder weight or the duration of menopause. A total of 94 women (30 without gynecologic or obstetric complaints, 31 with menopause less than 5 years and 33 menopause of 5 years or longer) were entered into the study. Bladder weights were determined ultrasonographically. The International Prostate Symptom Score questionnaire was used to evaluate lower urinary tract symptoms. A negative correlation was found between bladder weight and the duration of menopause. There was no significant difference between the three groups in terms of overall symptom scores. However, urgency incontinence score was the highest in the early postmenopausal period. In addition, the postmenopausal women had a significant negative correlation between the duration of menopause and frequent voiding scores. It was concluded that, ultrasonographically measured bladder weight decreases with the duration of menopause. Detailed studies with larger numbers of older women are needed to determine clearly whether this decrease in bladder weight has more significant effects on lower urinary tract symptoms.

The effects of fluoxetine on several neurophysiological variables in patients with premature ejaculation.

PURPOSE: Fluoxetine, a selective serotonin re-uptake inhibitor, has been shown to increase the intravaginal latency of patients with premature ejaculation. We demonstrated the effects of fluoxetine on intravaginal latency, penile sensory threshold, and variables of sacral evoked response and cortical somatosensorial evoked potential in patients with premature ejaculation. MATERIALS AND METHODS: Of 48 patients 40 who presented to our clinic with premature ejaculation met the study criteria, gave written or oral consent, and were divided randomly in a double-blind fashion into 2 groups of 20 patients. The study group received 20 mg. fluoxetine daily and the control group received placebo for 1 month. The patients were evaluated during visits before and after treatment for intravaginal latency, penile sensory threshold values, and the variables of sacral evoked response and cortical somatosensory evoked potential tests. RESULTS: Patient ages, intravaginal latencies, penile sensory threshold values, and amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests in both groups were not significantly different at the beginning of treatment (p >0.05). At the end of treatment intravaginal latencies and penile sensory threshold values were increased in the study group compared to before treatment and the control group (p <0.05). No change was observed in either group for the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests (p >0.05). CONCLUSIONS: These findings suggest that fluoxetine is effective treatment for premature ejaculation probably due to its effect of increasing the penile sensory threshold, without changing the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential.

Management of undeflatable Foley catheter balloons in women.

The inability to deflate a self-retaining balloon catheter is a rare problem but may be encountered by physicians. Many techniques have been described to solve the problem, some of which may be dangerous. The technique must not disturb the patient or create any additional morbidity. Those methods commonly used are the instillation of ether, liquid paraffin, chloroform or mineral oil through the inflation channel the use of a fine wire to burst the balloon or to recanalize the obstructed inflation channel; bursting or deflating the balloon through suprapubic, transvaginal or urethral routes: and the overinflation technique. The techniques which might be most appropriate for women are explained in a stepwise manner. First the catheter is cut in the proximal segment of the valve. If this is not successful, a ureteric catheter stylet is advanced through the inflation channel until it touches the balloon. If this is still unsuccessful, the balloon is deflated through the drainage channel using the technique proposed by Davies and Thomas. As a second choice, an intravenous cannula with its inner needle drawn back is advanced through the urethra next to the catheter; towards the balloon which, is then punctured with the inner needle. If these steps are followed, the patient will have no additional discomfort and no trauma to the surrounding tissues, and there will be no need for cystoscopy or any other expensive intervention.

A comparison of various methods to burst Foley catheter balloons and the risk of free-fragment formation.

OBJECTIVE: To compare the efficiencies of bursting balloons and the risks of forming free fragments after rupture using needles, the stylet of a ureteric catheter, instillation with ether or overinflation. MATERIALS AND METHODS: Two hundred 18 F 'silkolatex' Foley balloon catheters were divided into four groups of 50. Each balloon was inflated with 30 mL of distilled water, the catheters immersed in urine collected from healthy volunteers and maintained at 37 degrees C for 48 h. Attempts were made to burst the balloons with a needle (group 1), by overinflation (group 2), by ether instillation (group 3) and using the stylet of 7 F ureteric catheter through the inflation channel (group 4). RESULTS: The ratio of the burst to deflated balloons and the formation of free fragments were 100% and 0% in the group 1, 94% and 83% in the group 2, 100% and 100% in group 3 and 16% and 0% in the group 4, respectively. CONCLUSION: Bursting the catheter balloons using a needle seems to be the most appropriate method, being efficient and having little risk of forming free fragments.