Effect of COVID-19 infection on the erectile function.

OBJECTIVE: It has been understood that COVID-19, which has become a global pandemic in a short time, is a disease affecting multiple organs and systems. Some of the organs and systems affected by the disease also play a role in the pathophysiology of erectile dysfunction (ED), which led us to consider the possible effects of the disease on the erectile function. In this study, we aimed to evaluate changes in the erectile functions of patients with COVID-19 among those that had previously diagnosed with mild and moderate ED in our urology outpatient clinic. MATERIAL AND METHODS: Eighty-one patients aged 18-65 years who were confirmed to have COVID-19 were included in the study. According to disease severity, these patients were divided into two groups as mild (non-hospitalized, n = 60) and moderate (hospitalized but did not require intensive care, n = 21). The patients' pre- and post-disease scores in the five-item International Index of Erectile Function (IIEF-5) ​​and hormone panel results were compared. RESULTS: The changes in the IIEF-5 scores of the patients from the pre-disease to the post-disease period were statistically significant for both the mild and moderate groups (p < 0.05). When these changes were compared between the mild and moderate groups, the difference was not statistically significant (p = 0.156). There was also no statistically significant change in the testosterone, follicle-stimulating, luteinizing, and prolactin hormone levels before and after the disease. CONCLUSION: In this study, we determined that SARS-CoV-2 infection caused deterioration in existing ED in sexually active male individuals, regardless of the severity of the disease.

Effect of alpha-blocker use on morbidity and lower urinary tract symptoms in patients undergoing transrectal ultrasound-guided prostate biopsy.

OBJECTIVE: To evaluate voiding dysfunction and morbidity after transrectal ultrasound (TRUS)-guided prostate biopsy and to investigate whether pre-intervention alpha-blocker treatment had any effect on morbidity and voiding dysfunction. MATERIAL AND METHODS: The study included 197 consecutive patients who underwent TRUS-guided prostate biopsy between January 2014 and January 2018. The patients were divided into two groups, those receiving alpha-blocker (silodosin) and those not receiving alpha-blocker treatment before the procedure (controls). All patients were evaluated before and one week after the procedure with the International Prostate Symptom Score (IPSS), measurements of maximum flow rate (Qmax), post-void residual urine volume (PVR) and prostate volume, and procedure-related complications were also recorded. All analyzed parameters were compared by within-group and between-group evaluations. RESULTS: There was no significant difference between the two groups in terms of IPSS, Qmax and prostate volume values before biopsy. In the follow-up evaluation performed on the seventh day after biopsy, IPSS, PVR and prostate volume were found to be increased, whereas Qmax was decreased in the control group (p < 0.05). In the silodosin group, an increase in prostate volume was observed, but there were no significant changes in IPSS, Qmax and PVR values. Acute urinary retention (AUR) after the biopsy procedure developed in two patients (2%) in the silodosin group, and in nine patients (9.1%) in the control group (p = 0.02). No significant difference was found between the two groups in terms of biopsy-related complications, except for AUR. CONCLUSION: We believe that alpha-blocker treatment initiated before biopsy may be advantageous in preventing voiding dysfunction that may develop after the procedure.

Association between hyperlipidemia and prostatic enlargement: A case-control study.

OBJECTIVE: A high-fat diet is associated with the development of benign prostatic enlargement (BPE), but whether hyperlipidemia is associated with BPE remains unclear. This study aimed to evaluate whether hyperlipidemia is a risk factor for the development of BPE. MATERIAL AND METHODS: This study included 265 BPE patients with lower urinary tract symptoms (LUTS) and 248 age-matched healthy individuals without LUTS. The patient and control groups included in the study were compared in terms of fasting serum glucose, serum lipid values, prostate specific antigen (PSA), and prostate size measured by abdominal ultrasonography. RESULTS: The prostate sizes of the patient and healthy control group were 59.4 ± 12.6 and 41.8 ± 11.1 ml, respectively (p = 0.007). It was observed that the mean PSA value of the patient group (2.33 ± 1.69) was statistically higher than that of the control group (1.21 ± 1.05) (p = 0.002). Total cholesterol and LDL-cholesterol were significantly higher and HDL-cholesterol was significantly lower among the patients compared to the controls. Prostate size had a negative correlation with HDL-cholesterol and a positive correlation with LDL-cholesterol and total cholesterol. Additionally, LDL-cholesterol and total cholesterol were independent risk factors for prostate enlargement. CONCLUSION: This study indicates that increased levels of LDL-cholesterol and total cholesterol are significantly associated with the enlargement of the prostate. Hyperlipidemia may be one of the risk factors in the processes of prostatic growth and progression.

Relationship between heart rate recovery index and erectile dysfunction.

OBJECTIVE: Heart rate recovery (HRR) is a cardiac parameter that can be used to evaluate autonomic nervous system (ANS) function problems. We examined the possible relationship between erectile dysfunction (ED) and HRR which is a clinical condition associated with ANS dysfunction. METHODS: Seventy-six male patients that were examined with an exercise stress test and completed the International Index of Erectile Function Questionnaire Form (IIEF-5) were included in the study. The patients were divided into two groups as those with a normal HRR index (≥12, n=42) and those with an abnormal HRR index (<12, n=34). Then, statistical analyses were conducted to evaluate the correlations between ED and HRR. RESULTS: There were no differences between the groups in terms of risk factors, such as laboratory findings, age, BMI, hypertension, and smoking. However, in the group with an abnormal HRR index, the IIEF-5 score was significantly lower than the other group (11.2±4.2 vs. 20.3±4.6, p<0.001). A statistically significant positive correlation was observed between the IIEF-5 score and HRR index (r=0.702, p<0.001). In addition, the presence of diabetes mellitus and HRR index was independent risk factors for lowering the IIEF-5 score. CONCLUSION: The HRR index can be considered as an independent predictor of ED since a reduced value, which is associated with cardiovascular mortality and also causes ANS dysfunction.

Is heart rate variability a risk factor for premature ejaculation?

OBJECTIVE: The purpose of this study is to assess the parameters of heart rate variability, which is an indicator of the change in autonomic nervous system (ANS) activity, in individuals with premature ejaculation (PE). MATERIAL AND METHODS: This study was performed by comparing 40 patients with PE (mean age, 31.2 ± 4.1 years) and 40 healthy individuals (mean age, 30.4 ± 4.8 years) without PE from May 2018 to December 2019. HRV parameters were compared between men with PE and healthy controls in 24-hour heart rhythm Holter examination. RESULTS: In the time domain analysis, which is a subgroup of HRV, square root of differences between consecutive normal NN intervals (RMSSD), which is an indicator of parasympathetic activity, was lower in patients with PE compared with controls (P = .025). Moreover, within the frequency domain analysis, high frequency (HF), another indicator of parasympathetic activity, was lower in patients compared with controls (P = .032). Finally, the LF/HF ratio, reflecting sympathetic/parasympathetic activity ratio, was significantly higher in patients compared with controls (P = .008). Furthermore, the multivariate logistic regression analysis showed that LF/HF ratio is independently associated with PE (P = .005). The ROC curve analysis showed that the optimal cut-off value of LF/HF above 2.7 predicted PE at a sensitivity of 77.5% and specificity of 82.5% (positive predictive value: 81.5% and negative predictive value: 78.5%). CONCLUSION: Different HRV parameters were exhibited in the comparison of patients with PE and normal controls. It suggests that the change in HRV parameters will be an indicator of imbalance in ANS and this imbalance may cause PE. Therefore, HRV analysis can be a diagnostic tool to assess altered ANS activity in patients with PE and may be considered as a rapid screening tool.

Relationship between the Severity of Coronary Artery Disease and Overactive Bladder.

BACKGROUND: Overactive bladder is a urological disease that can seriously impair a person's quality of life, however its etiology remains unclear. The aim of this study was to evaluate the relationship between overactive bladder and SYNTAX score, which is based on coronary angiographic imaging to evaluate the severity of coronary artery disease. METHODS: A total of 380 patients diagnosed with coronary artery disease by coronary angiography were included in the study. Each participant completed the Overactive Bladder-Validated 8 questionnaire. The patients were divided into two groups as overactive bladder (n = 177; score ≥ 8), and non-overactive bladder (n = 203; score < 8). SYNTAX scores were calculated for both groups and compared. RESULTS: The SYNTAX score was significantly higher in the patients with overactive bladder (25.4 ± 4.2) than in those without an overactive bladder (18.3 ± 3.4) (p < 0.001). In addition, age, smoking rate, body mass index and diabetes mellitus were significantly higher and heart rate was significantly lower in the overactive bladder group (p < 0.001). In logistic regression analysis, the SYNTAX score was the sole independent predictor of overactive bladder (odds ratio: 1.47, 95% confidence interval: 1.35-9.19, p < 0.001). CONCLUSIONS: Our study suggests that the presence of a high SYNTAX score in patients with coronary artery disease may be associated with overactive bladder.

Short-term effects of COVID-19 on semen parameters: A multicenter study of 69 cases.

OBJECTIVE: COVID-19, which is known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health problem that can cause multiorgan damage because of its use of the angiotensin-converting enzyme 2 (ACE2) receptor in its pathophysiology. We aimed to investigate whether SARS-CoV-2 had a short-term effect on spermatogenesis, which plays an important role in male reproductive health as it has abundant ACE2 expression in testicular tissue. MATERIAL AND METHODS: This multicenter study included 69 patients aged 20-45 years, who admitted to our hospitals between April 2020 and October 2020 with a history of a positive test result for SARS-CoV-2 based on the nasopharyngeal or oropharyngeal swab samples and had recovered from the disease at least three months earlier and who had undergone a spermiogram test in the hospital database within the last year before the onset of disease. The patients were divided into two groups according to their COVID-19 symptoms being mild or moderate, depending on whether they had received home treatment or required hospitalization for oxygen therapy. Semen samples taken before and after COVID-19 were compared within and between the groups in terms of sperm parameters. RESULTS: The mean age of the patients included in the study was 30.4±4.8 years in the mild symptomatic COVID-19 group and 31.06±4.2 years in the moderate symptomatic group. When the spermiogram samples of the patients before and after COVID-19 were evaluated, it was found that motility and vitality significantly decreased in the mild symptomatic group, while the decrease in all semen parameters was statistically significant in the moderate symptomatic group. CONCLUSION: Although the mechanism by which COVID-19 causes testicular involvement remains uncertain, its short-term results on spermatogenesis reveals that COVID-19 negatively affects sperm parameters.

A rare cause of erectile dysfunction: left ventricular diastolic dysfunction.

BACKGROUND: The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease. METHODS: A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed. RESULTS: The mean age, Body Mass Index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (P>0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r=-0.635, P<0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score. CONCLUSIONS: This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.

Renal Parenchymal Volumetric Expansion Assessed by CT Imaging After Laparoscopic Cyst Decortication.

PURPOSE: To delineate the expansion of the renal parenchyma using volumetric CT imaging before and after the laparoscopic cyst decortication procedure and to determine the possible associations between parenchymal expansion and laboratory parameters and cyst volume. MATERIALS AND METHODS: Thirty-five patients that underwent laparoscopic cyst decortication were included in this prospective study. Abdominal contrast-enhanced CT was performed in all patients in the preoperative and postoperative period. Semi-automatic volume quantification was undertaken offline, and renal parenchymal volumes before and after cyst decortication, as well as serum creatinine and estimated glomerular filtration rate (eGFR) were compared. RESULTS: The changes in serum creatinine and eGFR in the postoperative period were non-significant. The mean postoperative renal parenchymal volumes were higher compared to the preoperative measurements for both observations (P = .014 and .034 for the first and second measurements, respectively). There was no correlation between the volumetric change and the cyst volume (r = -0.18, P = .560). CONCLUSION: In patients undergoing laparoscopic cyst decortication, post-operative parenchymal expansion can be detected using volumetric CT imaging to confirm the immediate benefits of the procedure.

Predictor Role of Pretreatment Resistive and Pulsatile Indexes in the Success of Medical Expulsive Therapy of Ureteral Stones.

OBJECTIVE: To investigate the role of renal resistive index (RI) and pulsatile index levels measured with renal Doppler ultrasonography in predicting the success of medical expulsive treatment in patients with ureteral stones. MATERIALS AND METHODS: Patients admitted to our clinic between January and December 2017 with a ureteral stone of less than 1 cm in diameter were evaluated in terms of their RI and pulsatile index values obtained using Doppler ultrasonography, and the localization and diameter of their stone and grade of hydronephrosis using computed tomography at the time of admission. After 4 weeks of medical expulsive treatment with tamsulosin, spontaneous stone passage was assessed to investigate the relationship between the data obtained before treatment and the success of medical expulsive treatment. RESULTS: Forty-eight of 71 patients passed the stone spontaneously after treatment (67.6%). Among the related variables, the largest diameter of stone and ipsilateral RI levels were independently associated with the success of medical expulsive treatment (P <.001). In the receiver operating characteristic curve analysis, a RI value of less than 0.72 was associated with spontaneous stone expulsion with a sensitivity of 89.6%, a specificity of 69.6%, and a positive predictive value of 97%. CONCLUSION: It is possible to predict the success of medical expulsive treatment using RI levels. We anticipate that in patients who are not likely to pass the stones spontaneously with medical treatment, surgery should not be postponed to avoid irreversible kidney damage.

Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease.

We investigated the effect of spinal anesthesia combined with obturator nerve block (ONB) during the transurethral resection of lateral bladder wall tumors (TUR-BT) on the presence of detrusor muscle tissue in tumor specimens and on tumor recurrence. TUR-BT was performed on 96 patients with a lateral bladder wall tumor under spinal anesthesia in our clinic between January 2011 and December 2015. The patients were divided into two groups: 49 patients only received spinal anesthesia and 47 patients received spinal anesthesia combined with ONB. The groups were retrospectively compared in terms of adductor muscle contraction, bladder perforation, complete tumor resection, presence of muscle tissue in the pathology material, and recurrence rate during follow-up. The obturator reflex was significantly observed in the non-ONB group (p < 0.05). In the ONB group, the percentages of complete resection and detrusor muscle tissue were significantly higher (p = 0.003 and p = 0.001, respectively). The postoperative recurrence rate was found to be significantly higher in the non-ONB group than in the ONB group (p = 0.025). Spinal anesthesia combined with ONB during TUR-BT prevent obturator reflex and facilitate complete resection including detrusor muscle tissue, independent from the size or number of tumors, thus reducing the recurrence of the disease.

Effect of age on biochemical recurrence after radical prostatectomy.

The aim of the study was to evaluate the relationship between patient's age and biochemical recurrence (BCR) after radical retropubic prostatectomy (RRP). Data from RRP applied to 305 patients with clinically localized prostate cancer were included in the study. Patients were divided into the three age groups, < 60 years, 60-70 years, and > 70 years. The groups were compared regarding adverse pathological findings on RRP specimen, BCR, and biochemical recurrence-free survival (bRFS) rates. The rates of positive surgical margin, seminal vesicle invasion, lymph node involvement, RRP specimens' Gleason score, and BCR were not significantly different among the three age groups. bRFS rates were not different either. Nonorgan-confined disease and extracapsular extension (ECE) rates were significantly higher in the group of 60-70 years group than in the other two age groups. Factors associated with BCR in multivariate Cox regression analysis were ECE, seminal vesicle invasion, positive surgical margin, and RRP specimens' Gleason score of ≥ 4+3. Patient age and preoperative prostate specific antigen levels were not identified to be associated with BCR. Post-RRP nonorgan-confined disease and ECE are more frequently seen in patients of 60-70 years of age group than in other age groups. However, patient age is not an independent prognostic factor associated with bRFS.

Intravesical migration of intrauterine device mimicking bladder stone on radiologic imaging: a case report.

Due to its high cost-effectiveness, intrauterine device (IUD) is one of the widely used contraception methods worldwide. Intravesical migration of an IUD via perforation of the uterus and bladder is very rare. Endoscopic approach is recommended in the treatment, but open surgery may also be needed rarely. In this report, we present the case of a 37-year-old female who was misdiagnosed radiologically with bladder stone, but later on, it was understood that an IUD migrated to the bladder and resulted in stone formation. Laser lithotripsy was performed, and the migrated IUD was unearthed. Removal of the IUD with cystoscopic forceps was unsuccessful. Postoperative pelvic computed tomography revealed that a part of the IUD was outside the bladder. At the next operation session, laparoscopic removal of the IUD was applied. The patient was followed up for 5 days with a Foley catheter and discharged after performing cystography, assuring us that the bladder contours were normal.

Evaluation of biochemical recurrence-free survival after radical prostatectomy by cancer of the prostate risk assessment post-surgical (CAPRA-S) score.

BACKGROUND: The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostate cancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus, CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen (PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion, extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In the present study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP) were evaluated by the CAPRA-S scoring system and its three-risk level model. MATERIALS AND METHODS: CAPRA-S scores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated. Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate and high. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportional hazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). RESULTS: BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was 51.7±33.0 months. Mean BCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and high risk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups was significant (P=0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilities in 5-yr were 0.87 and 0.81, respectively. CONCLUSIONS: Both CAPRA-S score and its three-risk level model well predicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operative risk stratifier and disease recurrence predictor for prostate cancer.