The impact of hyperthyroidism on sexual functions in men and women: a systematic review and meta-analysis.

This study aimed to review the current knowledge on sexual dysfunction in men and women with hyperthyroidism through a systematic review and meta-analysis. Available clinical trials from the MEDLINE database were searched using a prerecorded protocol (Protocol Prospero ID: CRD42022340587), and obtained data were analyzed and reported according to the PRISMA guidelines. Pooled effect estimates were computed using a random-effects model. Twenty eligible studies were identified, of which 15 were included in this meta-analysis. The prevalence of erectile dysfunction was significantly higher in participants with hyperthyroidism than that in controls [odds ratio = 9.16 (95% confidence interval [CI], 5.0-16.5)]. Treatment of hyperthyroidism alone improved erectile functions [effect size, ES = 0.36 (95% CI, -0.01-72)] and mean intra-vaginal ejaculation latency time [ES = 0.63 (95% CI, 0.27-98)] among men with erectile dysfunction and/or premature ejaculation. The prevalence of premature ejaculation also decreased with treatment of hyperthyroidism [odds ratio = 0.11 (95% CI, 0.04-28). Women with hyperthyroidism demonstrated higher odds in female sexual dysfunction than controls [odds ratio = 4.34 (95% CI, 2.63-7.18)]. Female sexual function index scores in women with hyperthyroidism were also significantly lower than those in the controls with moderate effect sizes. An evident and reversible disruption of sexual functions under hyperthyroidism conditions was observed in both sexes.

Systematic review and meta-analysis for the value of thyroid disorder screening in men with ejaculatory dysfunction.

OBJECTIVE: To demonstrate evidence from available clinical studies to clarify the scientific points that have been achieved in relation to thyroid disorders and ejaculatory dysfunction (EjD). DATA SOURCES: Clinical trial articles published in English on Medline. ELIGIBILITY CRITERIA: Clinical studies that investigated the association of thyroid disorders with the ejaculatory function of subjects and the trials evaluating the effect of thyroid dysfunction treatment on the ejaculatory function of the subjects were eligible. SYNTHESIS METHODS: We searched Medline with "ejaculation" and different combinations of "thyroid," "serum TSH," "serum T3," "serum T4" keywords in PubMed. RESULTS: Standardised mean serum thyroid-stimulating hormone (TSH) levels in premature ejaculation (PE) sufferers differed from non-PE control subjects (P = .05). Hyperthyroidism was associated with increased odds among PE subjects (OR = 2.0, P = .03). Delayed ejaculation was seen with increased odds in hypothyroid patients compared with hyperthyroidism patients (OR = 57, P = .0001). Serum TSH and mean intra-vaginal ejaculation latency time (IELT) of the subjects showed a correlation both before and after treatment for thyroid disorder. Treatment of thyroid disorders improved the mean IELT measures of the subjects. The overall estimate of the effect of hyperthyroidism treatment on mean IELT was .64 (P = .0001) in the random-effects model. LIMITATIONS: The low quality and quantity of evidence from available studies limited the interpretation of our study findings. CONCLUSIONS: The causal relationship between EjD and thyroid disorders remains to be clarified. Sufferers of delayed ejaculation acquired PE subjects, and PE sufferers who have accompanying erectile dysfunction and/or anxiety may benefit from thyroid disorder investigation.

The relationship between premature ejaculation and the timing of pre-adult circumcision.

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.

Effects of androgen deprivation therapy on cognitive functions in patients with metastatic prostate cancer: A multicentric, prospective study of the Society of Urological Surgery Andrology group.

AIMS OF THE STUDY: The aim of this study was to investigate the impact of testosterone deficiency on cognitive functions in metastatic prostate cancer patients receiving androgen deprivation therapy (ADT). METHODS: In this multicentric prospective study, 65 metastatic prostate cancer patients were evaluated. Demographic and clinical data were recorded. Cognitive functions were assessed using the Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test-Revised, and the Trail Making Test. Depressive symptoms were assessed using the Beck Depression Inventory. Cognitive functions and depressive symptoms were recorded before the androgen deprivation therapy and at the 3- and 6-month follow-ups. RESULTS: At the basal cognitive assessment, the mean Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test-Revised scores were 25.84 ± 17.54, 32.68 ± 10.60, and 17.63 ± 11.23, respectively, and the mean time for the Trail Making Test was 221.56 ± 92.44 seconds, and were similar at the 3-month, and 6-month controls (P > .05). The mean pretreatment, third and sixth month testosterone levels were 381.40 ± 157.53 ng/dL, 21.61 ± 9.09 ng/dL and 12.25 ± 6.45 ng/dL (P < .05), and the total PSA levels were 46.46 ± 37.83 ng/mL, 1.41 ± 3.31 ng/mL and 0.08 ± 0.14 ng/mL (P < .05), respectively. CONCLUSION: The ADT in patients with metastatic prostate cancer does not affect patients' cognitive functions and depressive symptoms. However, further prospective randomised studies with higher cohorts and longer follow-up periods are needed.

Mechanisms and grading of nocturia: Results from a multicentre prospective study.

OBJECTIVE: To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. METHODOLOGY: After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P < .05 was deemed as statistically significant. RESULTS: About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. CONCLUSIONS: Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.

Frequent witnessing to interparental conflict and low parental availability for leisure-time is associated with dysfunctional voiding in primary school children.

AIM: Aspects of parenting are an under-investigated topic amongst children with voiding complaints. We aimed to investigate the association between voiding complaints amongst children and two specific parenting-related behaviours: 1) parental availability during the child's leisure time and 2) frequency of witnessing interparental conflict. MATERIAL AND METHOD: Children aged between 6 and 11 years with their parents were the participants. Two survey forms and informed consent form were sent to potential participants via children's teacher. Voiding dysfunction complaints were evaluated with the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS). RESULTS: Data analyses were performed with 1101 eligible participants. The mean duration of parental availability during the child's leisure time was below 2 hours per day. Nearly one out of every four children witnessed interparental conflict at least once a month. Age, educational level of the mother, parental availability for the child's leisure time, and frequency of witnessing parental conflicts were found to be significantly associated with DVISS ratings. Adjusting age, socioeconomic level, and educational level of the parents and later adjusting parental availability during the child's leisure time did not change the association of frequency of witnessing interparental conflict with DVISS rates. An increase in the age, educational level of the mother, and parental availability during the child's leisure time was correlated with better scores on DVISS, while an increase in the frequency of witnessing interparental conflict strongly correlated with worse scores. CONCLUSION: Exposing children to interparental conflicts and shorter togetherness with their leisure time is associated with voiding complaints.

Changing Aspects of Male Sexual Functions Accompanying Treatment of Benign Prostatic Hyperplasia With Silodosin 8 mg Per Day.

BACKGROUND: Alpha-adrenergic antagonist treatment for benign prostatic hyperplasia (BPH) and drug-related sexual side effects are frequent in aging men. AIM: To investigate functional changes in erectile and ejaculatory aspects of male sexuality under Silodosin 8 mg per day treatment for BPH. METHODS: Sexually active patients diagnosed with BPH and who initiated Silodosin treatment were the subjects of the study. The International Prostate Symptom Score, premature ejaculation patient profile (PEP-male) questionnaire, Sexual Health Inventory for Men (SHIM) questionnaire, and estimated intravaginal ejaculation latency time (IELT) values of the participants were used to evaluate sexual functions. Data evaluation was performed in 8 urology clinics retrospectively. OUTCOMES: Participant ratings for SHIM, PEP, and estimated IELT were the primary outcome measures in the study. RESULTS: Among 187 recruited patients, data of 98 patients, who completed the trial period in the study, were eligible. The median age of the eligible participants who completed the trial period for 3 months was 59.5 years (range 45-82). 16 patients of 187 (8%) reported a desire for drug withdrawal for anejaculation during the recruitment period. 46 (46.9%) and 49 (50%) patients reported anejaculation in the first and third month of the treatment, respectively. De novo erectile dysfunction was noticed in 15 patients (15.3%). There was a significant increase in the estimated IELT of subjects in both the first (P = .01) and third (P = .002) month. SHIM-1 (P = .008), SHIM-total (P = .009), and PEP scores (P = .008) were also improved in the third month of the treatment. Neither baseline patient characteristics nor changes in the International Prostate Symptom Score after treatment predicted final outcomes with multivariable analysis. The subgroup analysis of participants who reported "anejaculation" also revealed better outcomes compared with participants ejaculating naturally in the third month as per SHIM ratings. CLINICAL IMPLICATIONS: Despite several male patients having dry orgasms due to Silodosin-induced anejaculation, the majority experienced improved erectile function. STRENGTHS & LIMITATIONS: The present study demonstrated pioneering results while investigating both erectile and ejaculatory dimensions of the male sexual function during Silodosin treatment for BPH. However, lack of partner evaluation, low follow-up rates, and lack of knowledge about reasons why subjects are lost to follow-up after drug initiation have limited our interpretation. CONCLUSION: Most patients using Silodosin 8 mg per day for BPH treatment experienced improvement in their erectile function, estimated IELT, and premature ejaculation profile in the third month of the treatment. Underlying mechanisms and reasons for individual differences necessitate further investigation. Cihan A, Kazaz IO, Yildirim Ö, et al. Changing Aspects of Male Sexual Functions Accompanying Treatment of Benign Prostatic Hyperplasia With Silodosin 8 mg Per Day. J Sex Med 2020;17:1094-1100.

A mixed integer linear programming model for long-term planning of municipal solid waste management systems: Against restricted mass balances.

Long-term planning of municipal solid waste management systems is a complex decision making problem which includes a large number of decision layers. Since all different waste treatment and disposal processes will show different responses to each municipal solid waste component, it is necessary to separately evaluate all waste components for all processes. This obligation creates an obstacle in the programming of mass balances for long-term planning of municipal solid waste management systems. The development of an ideal mixed integer linear programming model that can simultaneously respond to all essential decision layers including waste collection, process selection, waste allocation, transportation, location selection, and capacity assessment has not been made possible yet due to this important modeling obstacle. According to the current knowledge of the literature, all mixed integer linear programming studies aiming to address this obstacle so far have had to restrict many different possibilities in their mass balances. In this study, a novel mixed integer linear programming model was formulated. ALOMWASTE, the new model structure developed in this study, was built to take into consideration different process, capacity, and location possibilities that may occur in complex waste management processes at the same time. The results obtained from a case study showed the feasibility of new mixed integer linear programming model obtained in this study for the simultaneous solution of all essential decision layers in an unrestricted mass balance. The model is also able to provide significant convenience for the multi-objective optimization of financial-environmental-social costs and the solution of some uncertainty problems of decision-making tools such as life cycle assessment.

Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones.

PURPOSE: We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. METHODS: The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. RESULTS: Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%, p < 0.001). CONCLUSIONS: The optimal timing; 2-3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.

Predictive Factors of Ureterorenoscopy Outcomes in Proximal Ureteral Stones: A Multicenter Study of Aegean Study Group of the Society of Urological Surgery.

INTRODUCTION: We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study. MATERIALS AND METHODS: The data of patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients. RESULTS: A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% [CI] = 0.963-0.996, p = 0.018), stone area (OR = 0.993, 95% [CI] = 0.989-0.997, p = 0.002), and operation time (OR = 0.981, 95% [CI] = 0.968-0.994, p = 0.005). CONCLUSIONS: To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.

Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression.

INTRODUCTION: The findings regarding the association between body mass index (BMI) and sexuality outcomes are mixed. Subjective body image has been found to be more salient in predicting sexual function than actual body size. Previous studies have demonstrated appearance anxiety to be particularly significant. AIM: To evaluate the association between appearance anxiety and female sexual functions. Specific aims included the evaluation of body morphologic measurements with indicators other than BMI and determining the predictive role of surgical scars for appearance anxiety and female sexual function. METHODS: Sexually active women who had been in a stable heterosexual relationship for ≥6 months participated in this study. Demographic features, anthropometric measurements including BMI, skin-fold thickness (SFT) measurements from 3 regions of the body (triceps, scapula, and abdomen) and waist circumference (WC) were assessed. Finally, participants were asked to complete the Appearance Anxiety Inventory, Female Sexual Function Index, and Beck Depression Inventory. Multivariate path analyses and hierarchical multiple regression analyses were performed. MAIN OUTCOME MEASURES: The correlations of age, BMI, presence of surgical scars, and measurements of BMI, WC, and SFT as independent variables with Beck Depression Inventory, Appearance Anxiety Inventory, and Female Sexual Function Index scores were the main outcomes of the study. RESULTS: The data of 329 women were analyzed. The median age of the participants was 33 (19-52) years. The mean BMI was 24.5 (SD 3.5) kg/m2. The prevalence of female sexual dysfunction was 22.8%. Multivariate analyses revealed that increased appearance anxiety (-0.45), presence of surgical scars (-0.28), accompanying depression (-0.15), SFT abdomen measurement (-0.16), and age (-0.13) were significantly associated with sexual function. Appearance anxiety was found to be associated with accompanying depression (0.56), presence of surgical scar (0.38), and measurements of the WC (0.22), BMI (0.14), SFT-abdomen (0.12), and SFT-triceps (-0.31). CLINICAL IMPLICATIONS: Clinicians should take the strong relationship between appearance anxiety and female sexual function into consideration. Body morphologic evaluation should not be limited to BMI; surgical scars and WC and SFT measurements may play a considerable role. STRENGTHS & LIMITATIONS: A major limitation of this study was the lack of personal distress evaluation in the participants. CONCLUSION: Sexual complaints in middle-aged women revealed the strongest correlation with appearance anxiety. Further longitudinal studies are needed to reveal its underlying factors and implications for sexuality. Cihan A, Cihan E. Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression. J Sex Med 2019;16:1769-1778.

Temporal color mixing and dynamic beam shaping with silicon metasurfaces.

Metasurfaces offer the possibility to shape optical wavefronts with an ultracompact, planar form factor. However, most metasurfaces are static, and their optical functions are fixed after the fabrication process. Many modern optical systems require dynamic manipulation of light, and this is now driving the development of electrically reconfigurable metasurfaces. We can realize metasurfaces with fast (>105 hertz), electrically tunable pixels that offer complete (0- to 2π) phase control and large amplitude modulation of scattered waves through the microelectromechanical movement of silicon antenna arrays created in standard silicon-on-insulator technology. Our approach can be used to realize a platform technology that enables low-voltage operation of pixels for temporal color mixing and continuous, dynamic beam steering and light focusing.

Expert system application for prioritizing preventive actions for shift work: shift expert.

INTRODUCTION: Shift patterns, work hours, work arrangements and worker motivations have increasingly become key factors for job performance. The main objective of this article is to design an expert system that identifies the negative effects of shift work and prioritizes mitigation efforts according to their importance in preventing these negative effects. The proposed expert system will be referred to as the shift expert. METHODS: A thorough literature review is conducted to determine the effects of shift work on workers. Our work indicates that shift work is linked to demographic variables, sleepiness and fatigue, health and well-being, and social and domestic conditions. These parameters constitute the sections of a questionnaire designed to focus on 26 important issues related to shift work. The shift expert is then constructed to provide prevention advice at the individual and organizational levels, and it prioritizes this advice using a fuzzy analytic hierarchy process model, which considers comparison matrices provided by users during the prioritization process. An empirical study of 61 workers working on three rotating shifts is performed. After administering the questionnaires, the collected data are analyzed statistically, and then the shift expert produces individual and organizational recommendations for these workers.

Possibility of the most cost efficient choice: a divided process approach to method and location selection for municipal solid waste management.

As studies on municipal solid waste management increased in recent years, many new mathematical models and approaches with a focus on determining the best treatment and disposal scenario were developed and applied. In this study, a mixed integer linear programming model was developed to be used as a facilitative tool for the cost minimisation of municipal solid waste management practices. Since municipal solid waste mass is a mixed composition of various types of waste components with different physical and chemical properties, the model was designed to include all the suitable treatment and disposal methods for these different waste components. The method alternatives with multiple waste inputs, such as aerobic biological treatment and the thermal processes, were divided into a number of inputs to remove their non-linear structures. This way, linear programming could be used, and the linear cost function could be minimised over a set of linear constraints with integer variables. The model was applied to the city of Kocaeli, which will require a new waste management application in the future, beginning from 2015. The results obtained for different haul distance constraints in the study area were presented and assessed. The results showed that all the information required for a comprehensive management task could be modelled by a linear optimisation model with a divided processes approach easily.

Type-tunable amplified spontaneous emission from core-seeded CdSe/CdS nanorods controlled by exciton-exciton interaction.

Type-tunable optical gain performance of core-seeded CdSe/CdS nanorods is studied via two-photon optical pumping. Controlling the exciton-exciton interaction by varying the core and shell size, blue-shifted and red-shifted modes of amplified spontaneous emission are systematically demonstrated and their type attributions are verified by time-resolved emission kinetics.

Nanocrystal skins with exciton funneling for photosensing.

Highly photosensitive nanocrystal (NC) skins based on exciton funneling are proposed and demonstrated using a graded bandgap profile across which no external bias is applied in operation for light-sensing. Four types of gradient NC skin devices (GNS) made of NC monolayers of distinct sizes with photovoltage readout are fabricated and comparatively studied. In all structures, polyelectrolyte polymers separating CdTe NC monolayers set the interparticle distances between the monolayers of ligand-free NCs to <1 nm. In this photosensitive GNS platform, excitons funnel along the gradually decreasing bandgap gradient of cascaded NC monolayers, and are finally captured by the NC monolayer with the smallest bandgap interfacing the metal electrode. Time-resolved measurements of the cascaded NC skins are conducted at the donor and acceptor wavelengths, and the exciton transfer process is confirmed in these active structures. These findings are expected to enable large-area GNS-based photosensing with highly efficient full-spectrum conversion.

Observation of biexcitons in nanocrystal solids in the presence of photocharging.

In nanocrystal quantum dots (NQDs), generating multiexcitons offers an enabling tool for enhancing NQD-based devices. However, the photocharging effect makes understanding multiexciton kinetics in NQD solids fundamentally challenging, which is critically important for solid-state devices. To date, this lack of understanding and the spectral-temporal aspects of the multiexciton recombination still remain unresolved in solid NQD ensembles, which is mainly due to the confusion with recombination of carriers in charged NQDs. In this work, we reveal the spectral-temporal behavior of biexcitons (BXs) in the presence of photocharging using near-unity quantum yield CdSe/CdS NQDs exhibiting substantial suppression of Auger recombination. Here, recombinations of biexcitons and single excitons (Xs) are successfully resolved in the presence of trions in the ensemble measurements of time-correlated single-photon counting at variable excitation intensities and varying emission wavelengths. The spectral behaviors of BXs and Xs are obtained for three NQD samples with different core sizes, revealing the strength tunability of the X-X interaction energy in these NQDs. The extraction of spectrally resolved X, BX, and trion kinetics, which are otherwise spectrally unresolved, is enabled by our approach introducing integrated time-resolved fluorescence. The results are further experimentally verified by cross-checking excitation intensity and exposure time dependencies as well as the temporal evolutions of the photoluminescence spectra, all of which prove to be consistent. The BX and X energies are also confirmed by theoretical calculations. These findings fill an important gap in understanding the spectral dynamics of multiexcitons in such NQD solids under the influence of photocharging effects, paving the way to engineering of multiexciton kinetics in nanocrystal optoelectronics, including NQD-based lasing, photovoltaics, and photodetection.

Effects of intraperitoneal nitroglycerin on the strength and healing attitude of anastomosis of rat intestines with ischemia-reperfusion injury.

BACKGROUND: Ischemic conditions in the intestine result in deterioration of anastomosis healing process. In this study, our aim was to evaluate the possible effects of intraperitoneal nitroglycerin on the intestinal anastomosis healing and anastomosis burst pressures in rats with ischemia and reperfusion injury (I/R). MATERIALS AND METHODS: Fifty four Wistar albino rats were divided into six groups. In the first two groups, the rats underwent I/R. In the Group 1, the rats had normal saline (S) and in Group 2, the rats had nitroglycerin (N) injection. In the 3 rd and 4 th groups, an intestinal anastomosis was made at the 10 cm proximally to the ileocecal valve. In Group 3, S and in Group 4, N were injected. In Group 5, the rats received I/R, intestinal anastomosis and intraperitoneal S injection. I/R, intestinal anastomosis and intraperitoneal N injection were made in Group 6 rats. All nitroglycerin (50 µg/kg) injections were made at postoperative days of 0, 1, 2, 3, 4, 5 consecutively. On the sixth day, all rats were killed. In all rats with anastomosis, anastomotic burst pressure (ABP) was measured. Histopathological specimens were collected from all rats and evaluated under light microscopy. RESULTS: Serious tissue damage was only detected in the Group 1 histopathologically (8 rats had grade 4 damage). In Group 2, there was a decrease in tissue damage according to histopathologic examination (5 rats had grade 1 damage). The effect onto the healing was similar in S and N groups. Nitroglycerin was noted to have a positive effect on collagen production. Nitroglycerin increased the ABP levels in rats both with and without I/R (the means are 17.93, 21.10, 14.67, and 17.63 in Groups 3, 4, 5, and 6, respectively). CONCLUSION: I/R may weaken the strength of intestinal anastomosis. Intraperitoneal application of nitroglycerin may prevent the histopathologic changes within a limited degree. Intraperitoneal nitroglycerin has also positive effects on the healing of intestinal anastomosis of rats with and without I/R. It may increase the fibroblast proliferation and the strength of the anastomosis.

The giant calculus within the prostatic urethra.

The giant calculus within the prostatic urethra is a rare clinical entity in the young population. Most of the calculi within the urethra migrate from the urinary bladder and obliterate the urethra. These stones are often composed of calcium phosphate or calcium oxalate. The decision of treatment strategy is affected by the size, shape and position of the calculus and by the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most cases, the giant calculi were extracted via the transvesical approach and external urethrotomy. Our case is the biggest prostatic calculus, known in the literature so far, which was treated endoscopically by the combination of laser and the pneumatic lithotriptor.

Investigation of the neural target level of hyperthyroidism in premature ejaculation in a rat model of pharmacologically induced ejaculation.

INTRODUCTION: Association between hyperthyroidism and premature ejaculation was demonstrated in clinical studies. AIM: The aim of this study is to determine the target level of changes on ejaculatory physiology under hyperthyroid states. METHODS: p-Chloroamphetamine (PCA)-induced pharmacologic ejaculation model with 24 male Wistar rats was used in the study. Subcutaneous injection of L-thyroxine for 14 days was performed to induce hyperthyroidism. At the end of the injection period, thyroid hormone status was evaluated by serum thyroid-stimulating hormone measurements in all rats. At the beginning of the operations, complete spinal transections (tx) at the T8-T9 level were performed to half of the L-thyroxine-injected and control group rats. Thus, experimental groups were constructed as follows: Group 1--control-spinal intact (n=6), group 2-control-spinal tx (n=6), group 3-hyperthyroid-spinal intact (n=6), and group 4-hyperthyroid-spinal tx (n=6). Ejaculatory responses were recorded before and 30 minutes after intraperitoneal administration of 5 mg/kg PCA. MAIN OUTCOME MEASURES: During the operations, seminal vesicle (SV) catheterization and bulbospongiosus (BS) muscle dissections were performed in all rats to demonstrate SV pressure (SVP) BS electromyographic (EMG) activity changes. RESULTS: Following PCA administration SVP tonic amplitude, SV phasic contraction (SVPC) frequency, SVPC maximal amplitude, and BS EMG area under curve values were higher in hyperthyroid intact rats than in control intact rats. The time interval between PCA administration and first ejaculation of hyperthyroid intact rats were significantly shorter than control intact rats (261 ± 7.30 seconds vs. 426 ± 49.6 seconds, P=0.008). All of the changes in the ejaculatory parameters that were induced by hyperthyroidism were completely resolved after spinal transections at the T8-T9 level in group 4. CONCLUSION: In this study, we confirmed the recent data that hyperthyroidism affects both the emission and expulsion phases of ejaculation. The changes that were induced by hyperthyroidism on ejaculatory physiology probably take place in the supraspinal centers above T8 level.