Machine learning algorithm predicts urethral stricture following transurethral prostate resection.

PURPOSE: To predict the post transurethral prostate resection(TURP) urethral stricture probability by applying different machine learning algorithms using the data obtained from preoperative blood parameters. METHODS: A retrospective analysis of data from patients who underwent bipolar-TURP encompassing patient characteristics, preoperative routine blood test outcomes, and post-surgery uroflowmetry were used to develop and educate machine learning models. Various metrics, such as F1 score, model accuracy, negative predictive value, positive predictive value, sensitivity, specificity, Youden Index, ROC AUC value, and confidence interval for each model, were used to assess the predictive performance of machine learning models for urethral stricture development. RESULTS: A total of 109 patients' data (55 patients without urethral stricture and 54 patients with urethral stricture) were included in the study after implementing strict inclusion and exclusion criteria. The preoperative Platelet Distribution Width, Mean Platelet Volume, Plateletcrit, Activated Partial Thromboplastin Time, and Prothrombin Time values were statistically meaningful between the two cohorts. After applying the data to the machine learning systems, the accuracy prediction scores for the diverse algorithms were as follows: decision trees (0.82), logistic regression (0.82), random forests (0.91), support vector machines (0.86), K-nearest neighbors (0.82), and naïve Bayes (0.77). CONCLUSION: Our machine learning models' accuracy in predicting the post-TURP urethral stricture probability has demonstrated significant success. Exploring prospective studies that integrate supplementary variables has the potential to enhance the precision and accuracy of machine learning models, consequently progressing their ability to predict post-TURP urethral stricture risk.

Depictions of penises in historical paintings reflect changing perceptions of the ideal penis size.

OBJECTIVES: To investigate alterations in depicted penis size by evaluating nude male paintings from the 15th to 21st centuries. MATERIALS AND METHODS: Nude-male paintings were identified from various art history websites and analysed to determine changes in penis size over time. Two observers organised the paintings according to the century in which they were created and made the calculations. Penile length to ear length (PtEL) or penile length to nose length (PtNL) were calculated to standardise the measurements using professional image analysis software. PtEL was first attempted for all paintings; if PtEL could not be ascertained, then nose length was used instead of the ear, as the nose length is defined as equal to ear length according to the golden ratio. Thus, PtNL was ensured and both ratios were then referred to using a common term: penis depiction ratio (PDR). Further analysis was performed by dividing the paintings into three groups according to the historical development of art: Renaissance Period (1400-1599; 15th-16th centuries), Baroque-Rococo and Impressionism Period (1600-1899; 17th-19th centuries) and Contemporary Art Period (1900-2020; 20th and 21st centuries). RESULTS: Of 232 identified paintings, 72 (31.1%) were excluded because they depicted images of adolescents or an erect penis. The PDR was found to differ significantly between paintings created in different centuries (P < 0.001). Subgroup analysis revealed that paintings from the 21st century demonstrated significantly higher PDRs than paintings from previous centuries (P = 0.001). CONCLUSIONS: In paintings depicting nude males, the size of the penis has gradually increased throughout the past seven centuries, and especially after the 20th century. This observation illustrates the changing sociocultural inputs into male body image and emphasises the need for improved understanding of the sociocultural factors associated with the perception of penis size in men.

Usefulness of the four-variable formula on serial electrocardiograms in detecting subtle anterior myocardial infarction.

OBJECTIVE: To perform serial electrocardiogram (ECG) analyses in patients with subtle ECG changes in the anterior leads and evaluate the performance of the four-variable formula in detecting left anterior descending (LAD) coronary artery occlusion. METHODS: This prospective study included patients admitted to the emergency department with acute chest pain between April 2021 and January 2023, whose initial ECG was not diagnostic but indicated suspicion of myocardial infarction (MI) and who underwent percutaneous coronary intervention in their follow-up. The control group consisted of patients who were diagnosed with benign variant ST-segment elevation (BV-STE) due to ST-segment elevation (STE) of at least 1 mm in the anterior lead, who had normal cardiac troponin levels, and who presented with non-cardiac chest pain. Following admission, six ECGs were taken at 10-min intervals. The scores of all patients were calculated with the four-variable formula on serial ECGs and compared between the groups. RESULTS: A total of 232 patients, including 116 with anterior MI and 116 with BV-STE, were included in the study. When the cut-off value for the four-variable formula was taken as ≥18.2, the sensitivity, specificity, and diagnostic accuracy of the first ECG were determined to be 82.7%, 85.3%, and 83.6%, respectively. We found that the four-variable formula had the highest sensitivity, specificity, and diagnostic accuracy in detecting LAD occlusion for the ECG taken at the 20th minute (83.6%, 89.6%, and 86.2%, respectively). CONCLUSION: The four-variable formula was found to be a valid method for the differentiation of STEMI and BV-STE in patients with subtle ECG changes. While managing this patient group, using serial ECGs rather than a single ECG to evaluate the clinical status of patients can help clinicians make more accurate decisions.

Onco-TESE (Testicular Sperm Extraction): Insights from a Tertiary Center and Comprehensive Literature Analysis.

Background and Objectives: The peak of incidence of testicular cancer (TC) occurs among individuals in their reproductive age, emphasizing the importance of fertility preservation as an integral aspect of disease management. Sperm cryopreservation performed before orchiectomy is ineffective in azoospermic men, necessitating alternative approaches such as microdissection testicular sperm extraction (mTESE) at the time of orchiectomy (onco-mTESE) to obtain viable sperm. This study presents the findings from our institution's experience with onco-mTESE and critically discusses our results in light of the existing body of literature. Materials and Methods: This is a tertiary center retrospective analysis of onco-mTESE procedures performed at a single center between December 2011 and July 2022. The included patients were post-puberal men with testicular tumors requiring orchiectomy, along with concomitant severe oligozoospermia or azoospermia. Bilateral mTESE was performed in all cases. Surgical outcomes, sperm retrieval rates, the usage of preserved viable sperm, assistive reproductive techniques' results, and post-operative serum testosterone were recorded. Results: A total of nine patients were included, with a median age of 34 (IQR 29-36) years. All patients had germ cell tumors (GCTs), with seminomatous and non-seminomatous GCTs accounting for 44.4% (n = 4) and 55.6% (n = 5) of patients, respectively. Sperm retrieval occurred in three (33%) patients: one patient in the ipsilateral testis, one in the contralateral testis, and one in both testes. No complications were reported during the procedure, and no post-operative hypogonadism was observed. Among the three patients with successful sperm retrieval, an intracytoplasmic sperm injection (ICSI) was performed in two patients, resulting in two pregnancies, leading to one healthy live birth and one miscarriage. Conclusions: In the context of TC, it is essential to conduct a thorough evaluation of testicular function, including a semen analysis and cryopreservation. Onco-mTESE has proven its safety in preserving fertility in azoospermic cases while ensuring the efficacy of oncological treatment.

Predictive value of seminal oxidation-reduction potential analysis for reproductive outcomes of ICSI.

RESEARCH QUESTION: Is seminal oxidation-reduction potential (ORP) clinically relevant to reproductive outcome? DESIGN: Prospective observational study including a total of 144 couples who had an intracytoplasmic sperm injection (ICSI) cycle between June 2018 and December 2020. The study included patients undergoing fresh ICSI cycles with autologous gametes. Cycles that had day 3 embryo transfers and cryopreservation cycles were excluded. There was no restriction on patients with severe male infertility; couples with unexplained infertility and unexplained male infertility were included, those with azoospermia were excluded. Semen analysis, seminal ORP as determined by means of the MiOXSYS system, sperm DNA fragmentation (SDF) and reproductive outcomes (fertilization, blastocyst development, clinical pregnancy and live birth) were determined. RESULTS: Seminal ORP was significantly negatively correlated with fertilization rate (r = -0.267; P = 0.0012), blastocyst development rate (r = -0.432; P < 0.0001), implantation/clinical pregnancy (r = -0.305; P = 0.0003) and live birth (r = -0.366; P < 0.0001). Receiver operating characteristic curve analysis showed significant predictive power for ORP for fertilization (≥80%; area under the curve [AUC] 0.652; P = 0.0012), blastocyst development rate (≥60%; AUC 0.794; P < 0.0001), implantation/clinical pregnancy (AUC 0.680; P = 0.0002) and live birth (AUC 0.728; P < 0.0001). Comparable results were obtained for SDF (fertilization: AUC 0.678; blastocyst development: AUC 0.777; implantation/clinical pregnancy: AUC 0.665; live birth: AUC 0.723). Normal sperm morphology showed the lowest predictive power for all reproductive outcome parameters. With male age as confounding factor, ORP (cut-off value of 0.51 mV/106 sperm/ml) has significant (P < 0.04667) effects on odds ratios for all reproductive outcome parameters. Multivariate logistic regression to investigate potential seminal and female confounding factors revealed that seminal ORP significantly (P < 0.0039; P < 0.0130) affects reproductive outcome. CONCLUSION: Seminal ORP is relevant for good fertilization, blastocyst development, implantation, clinical pregnancy and live birth.

Evaluation of YouTube videos on primary bladder pain syndrome.

INTRODUCTION AND HYPOTHESIS: Seeking health information online has drastically increased. As primary bladder pain syndrome (PBPS) is a condition that has no definitive diagnosis and treatment protocol, patients may seek answers on YouTube. We aimed to evaluate the role of the videos related to PBPS hosted on YouTube. METHODS: We searched PBPS-related YouTube videos using the keywords "primary bladder pain syndrome," "painful bladder syndrome," and "interstitial cystitis." The videos not in English, not relevant, or that do not contain audio were excluded. The characteristics of the videos were collected. The videos were primarily classified as reliable and nonreliable based on the scientifically proven accurate information they contained. The overall quality of the videos was assessed by DISCERN and Global Quality Score (GQS). Intraclass correlation was used to calculate the level of agreement between the two investigators on DISCERN and GQS values. RESULTS: Of the 300 videos, 175 were excluded. A total of 62 (49.6%) videos were considered reliable and 63 (50.4%) nonreliable. Only video lengths differed statistically in favor of reliable videos (p < 0.001). DISCERN and GQS values were higher in the reliable videos group (p < 0.001 for each). The number of views, likes, dislikes, and comments were slightly lower in the videos uploaded from universities/nonprofit physicians or professional organizations than other groups. CONCLUSIONS: Although about half of the videos are reliable, most are long and are medical lectures, from which it is difficult for nonhealth professionals and patients to obtain information. On the other hand, most of the videos that patients can follow more easily consist of nonreliable video groups that lack accuracy, detail, and factual content. Therefore, the relevant associations with experts should prepare concise videos containing correct and up-to-date information.

The prognostic role of intra-aortic pulse pressure measured before percutaneous coronary intervention in patients with chronic coronary syndrome: a single-center, retrospective, observational cohort study.

BACKGROUND: The relationship between pulse pressure and prognosis in patients with chronic coronary syndrome (CCS) is contradictory. In the present study, we aimed to examine the relationship between intra-aortic pulse pressure (IAPP) and major adverse cardiovascular events (MACE) in patients with CCS undergoing percutaneous coronary intervention (PCI). METHODS: A total of 139 CCS patients who underwent elective PCI with regular one-year follow-up, were stratified into two subgroups according to IAPP. The primary outcomes included the occurrence of MACE, defined as cardiovascular death, acute myocardial infarction with ST-segment elevation (STEMI), acute myocardial infarction without ST-segment elevation (NSTEMI), target vessel revascularization (TVR), and stroke. RESULTS: The mean age of the patients was 57.6 ± 10.4 years, 32% of whom were female. The mean IAPP, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 54.0 ± 17.6 mmHg, 129.7 ± 20 mmHg, and 75.8 ± 11.8 mmHg, respectively. SBP, IAPP, and left ventricular ejection fraction (LVEF) were significantly higher in the high IAPP group (p < .001, p < .001, p = .001, respectively). The MACE rate was significantly higher in the low IAPP group than in the high IAPP group (30.4% vs. 8.6%, p = 0,001). The LVEF (OR = 0.93, CI:0.88-0.99, p = .025) and IAPP (OR = 0.89, CI:0.83-0.95, p = .001) were found to be independent predictors of MACE. The IAPP value of 39.5 mmHg was identified as an effective cutoff point for prediction of MACE-free survival rates (AUC:0.853, CI:0.768-0.937). CONCLUSION: Invasively measured IAPP has prognostic information about cardiovascular outcomes in patients with CCS. The risk of MACE is significantly greater in CCS patients with low IAPP compared with those who have high IAPP values.

ANXA2, SP17, SERPINA5, PRDX2 genes, and sperm DNA fragmentation differentially represented in male partners of infertile couples with normal and abnormal sperm parameters.

This study aims to evaluate the expression of genes associated with the fertilisation potential and embryo development, sperm DNA fragmentation (SDF), and acrosome reaction in male partners of infertile couples with different sperm parameters compared to fertile men. First, male partners of infertile couples with abnormal (N = 25) and normal sperm parameters (N = 25), and fertile men (N = 10) were included in experimental groups I, II, and controls respectively. The mRNA levels of the Annexin A2 (ANXA2), Sperm protein 17 (SP17), Plasma serine protease inhibitor (SERPINA5), and Peroxiredoxin-2 (PRDX2) genes and SDF were evaluated. To evaluate the maturity of the sperm and oxidative stress, the acrosome reaction, the lipid peroxidation, and total antioxidant were measured. As result, SP17 showed a significantly lower expression in both experimental groups. SERPINA5 was significantly down-regulated in experimental group I that was aligned with the low rate of acrosome reaction. Significant overexpression of PRDX2 was found between experimental group II and controls. Significant higher rates of SDF were seen in both experimental groups compared to the controls. Finally, our data suggest that differentially gene expression of SP17 is a potential diagnostic biomarker in infertile men either with normal or abnormal sperm parameters. SDF is one of the causes of male infertility, independent of the sperm parameters.

Foetal cardiac function in third trimester pregnancies with reduced fetal movements.

The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p = .003), higher tricuspid and mitral E/A (p < .001), and lower f-TAPSE values (p < .001). In regression analysis, f-TAPSE was the only parameter (p = .04) independently associated with poor perinatal outcome. In conclusion, examining f-TAPSE may predict adverse perinatal outcome in pregnancies with RFM.IMPACT STATEMENTWhat is already known on this subject? Reduced foetal movement (RFM) is associated with adverse pregnancy outcome. Cardiotocography, amniotic fluid assessment, estimated birthweight, foetal Doppler and formal foetal movement count (kick chart) are generally used in the clinical assessment of pregnancies with reduced foetal movements. These tests, we currently use to assess foetal wellbeing in women with reduced foetal movements, have limited sensitivity in predicting foetal compromise.What do the results of this study add? Foetal cardiac Doppler may potentially be used as an important adjunct to the conventional management of women with a perception of reduced foetal movements.What are the implications of these findings for clinical practice and/or further research? Foetal echocardiographic evaluation, such as f-TAPSE, may influence clinical practice by enabling improved risk stratification for poor perinatal outcome, thus allowing more timely definitive intervention. This could help to decrease the rate of stillbirth related to reduced foetal movements. The few established echocardiographically derived parameters, which can asses global right ventricle function, are not always easy to obtain, however, f-TAPSE is easily obtainable using ultrasound and it appears to be a clinically useful echocardiographic measurement of right ventricular function.

Effect of simple calculation and reading aloud on cognitive function and depression in postoperative older adults.

BACKGROUND: This study was conducted to determine the effect of simple calculation and reading aloud on postoperative cognitive function and depression level in older adults. METHOD: The study was a randomised controlled experimental study. A personal information form, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) were used for data collection. RESULTS: In the evaluation of MMSE and GDS scores of the intervention and control groups 4 weeks after the operation, the differences between the two groups were found to be statistically significant. CONCLUSION: The results found that simple calculation and reading aloud after surgery had a positive effect on cognitive function and depression level in older people.

An effective treatment option for pain caused by urolithiasis: A randomised-controlled trial of local active warming with heat-patch.

BACKGROUND: There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. METHODS: For this purpose, patients who were diagnosed with renal colic in the emergency department were randomised to have either heat-patch or sham treatment. The Visual Analogue Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0, 15, 30, 45, and 60 minutes. In addition, the salvage treatment needs of the groups were compared. RESULTS: The average age of the study group was 30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (P = .75). According to the baseline VAS score of the patients, 15, 30, 45, and 60 minutes VAS scores significantly decreased in the heat-patch group (P < .001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 minutes (P = .39 and P = .10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at 30, 45, and 60 minutes compared with the sham group (P < .001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (P = .01). CONCLUSION: As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicentre and large scale randomised studies.

A survey analysis of knowledge levels of urologists about radiation safety and fluoroscopy use.

AIMS: To evaluate the awareness of the use of fluoroscopy in endourological procedures, as well as the theoretical and practical applications of preventive measures. MATERIAL AND METHOD: Between May 2018 and April 2019, a 26-question survey prepared using Google Docs was sent to urologists via email. Personal information, radiation training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment were queried. RESULTS: A total of 226 participants fully completed and returned the email survey. Of the 226 participants, 78 (34.5%) were academics, 44 (19.4%) were residents while 104 (46.1%) were experts. More than 60% of the participants stated that they participated in the operation requiring less than five fluoroscopy use per week. The majority of operations requiring fluoroscopy consisted of endourological procedures. The lead apron was used by 93% of the participants, but the use of protective glasses and gloves was very low (3.5%). The majority of academicians, experts and residents did not use dosimeters (76.9%, 82.7% and 81.8%, respectively). More than 50% of the participants did not have literature information about the harmful effects of radiation with the use of fluoroscopy. The most common complaints on the day of fluoroscopy were fatigue and headache. CONCLUSION: The lack of information regarding the radiation protection measures and harmful effects of radiation is common among urologists in Turkey. Therefore, systematic training programs on fluoroscopy use and radiation exposure should be provided during urology residency.

Comparison of De Ritis Ratio and other systemic inflammatory parameters for the prediction of prognosis of patients with transitional cell bladder cancer.

OBJECTIVE: To investigate the clinical value of preoperative De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) (DRR) in patients with transitional cell bladder cancer (TCBC) at initial diagnosis. The secondary objective was to investigate the status of systemic inflammatory parameters, such as neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and platelet-monocyte ratio (PMR). MATERIALS AND METHODS: The records of patients with primary TCBC who underwent transurethral resection were retrospectively evaluated. The relationship of DRR and systemic inflammatory parameters with clinicopathological findings, recurrence and progression status was evaluated separately. RESULTS: There was no significant difference in the DRR according to the clinicopathological findings, recurrence and progression. Significant differences were found between the NLR and the patient groups for tumour diameter, tumour stage, tumour grade and progression. In univariate analysis, the LMR was found to be associated with progression, and also the PLR and LMR were found to be associated with recurrence. Decrease in LMR and increase in LMR score demonstrated by multiple analysis was shown as independent predictors of progression and recurrence development. CONCLUSIONS: This paper shows a positive correlation between poor prognosis in TCBC and the systemic inflammatory markers, namely NLR, LMR, PLR and PMR, but not DRR.

Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study.

BACKGROUND: Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients. METHODS: In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1­month and 6­month follow-up results. RESULTS: The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc­d, JTc, JTc­d, Tp­e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc­d (r = 0.449, p = 0.001), JTc­d (r = 0.324, p = 0.002), Tp­e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index. CONCLUSION: Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.

Comparison of Two Different Bipolar Energy Resources in Transurethral Resection of Bladder Tumors.

PURPOSE: To determine whether the use of different bipolar resources is associated with different results on tissue and perioperative parameters in patients undergoing bipolar transurethral bladder tumor resection (bTURBT). METHODS: In this single-center prospective study, patients diagnosed with bladder tumor randomized to undergo TURBT either with a Gyrus PlasmaKinetic system (n = 62) or Olympus TUR in saline (TURis) system (n = 51). Primary endpoint was to evaluate the alteration of patients' perioperative parameters, while secondary aim was to assess the thermal effect of these 2 different bipolar devices on the resected tissue samples by a grading system determined by tissue characteristics. RESULTS: One hundred thirteen patients were randomized in the study, and 43 were excluded from the analysis due to the exclusion criteria. There were no significant differences between the groups in terms of mean age, tumor site, number of tumors, operative time, alteration in hemoglobin or hematocrit, blood transfusion rate, catheterization time, and postoperative stay. On the other hand, the ratio of obturator jerk was significantly higher in the Olympus TURis group (p = 0.028). The histopathological analyses of both groups determined muscularis propria and cautery artifact presence without a statistically significant difference (χ2: 0.476, p = 0.788). CONCLUSION: Although the perioperative complications of bTURBT are low in nature, bladder perforation resulted from obturator jerk still poses a risk for extravesical tumor implantation. Urologists should be aware of this risk especially when they are using a TURis system.

Pain during sexual activity and ejaculation following hernia repair: A retrospective comparison of transabdominal preperitoneal versus Lichtenstein repair.

Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.

Seasonal fluctuation of erectile dysfunction: A cross-sectional study from a tertiary university hospital across 10 years.

Erectile dysfunction (ED) shares several risk factors with diabetes mellitus (DM), hypertension (HT) and coronary vascular disease (CVD), which were well-associated with seasonal fluctuation with the highest peak in winter. In this study, we aimed to determine whether ED demonstrates seasonal fluctuations with the above-mentioned systemic diseases. Database from a tertiary university hospital between 2010 and 2020 was deciphered to retrieve patients diagnosed with ED. Patients with primary bladder tumour and post-procedural ED constituted the negative control groups from the same study period. International index of erectile function questionnaire (IIEF-15) was used to segregate included patients into mild/moderate and severe ED groups. The probability of detecting DM, HT and CVD in patients with severe ED was significantly higher than that of with mild/moderate ED (p < 0.05). More ED symptoms emerged and were diagnosed in the winter seasons even though no statistical significance was observed between patients with mild/moderate and severe ED (p = 0.946, Cramer's V coefficient = 0.19). The seasonal variation of patients with bladder tumour and post-procedural ED groups showed no significant difference (p > 0.05, both). ED admissions are associated with higher peaks in the winter seasons. This may help in daily clinical practice to warrant better clinical and epidemiological interpretation of ED.

Bipolar prostate thermotherapy for the improvement of chronic prostatitis symptoms and ejaculation problems.

This study aims to evaluate the efficacy of the new bipolar radiofrequency thermotherapy device (TEMPRO) on urinary and sexual functions in patients with chronic prostatitis. Between April 2017 and September 2018, 42 male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were included. The patients had received at least 6 months of treatment via conventional medical treatments. NIH-Chronic Prostatitis Symptom Index (CPSI), International Index of Erectile Function-Erectile Function part (IEEF-EF), and Premature Ejaculation Profile (PEP). The intravaginal ejaculation latency times (IELT) of the patients were recorded before and 6th months after the procedure. Bipolar radiofrequency thermotherapy was applied with TEMPRO system containing a16Fr applicator. The mean age of the patients was 42.62 ± 8.25 years. All patients were treated with local anesthesia, and three patients were unable to complete the procedure. After 6 months, significant improvements were observed in the NIH-CPSI total (20.25 vs. 12.18; p < .001) and subgroup scores, PEP scores (0.98 ± 1.12 vs. 2.06 ± 1.03; p < .001) and IELT (68.24 ± 56.78 vs. 103.02 ± 188.56; p < .001). There was no significant difference between IIEF-EF scores. Symptomatic improvement was observed in 78.57% (33/42) of the patients. Bipolar radiofrequency thermotherapy, which is a transurethral method in patients with CP/CPPS, decreases the severity of the disease and improvement of the symptom scores on urinary and sexual function. Additional studies are required to further evaluate treatment effectiveness.

Effect of bipolar radiofrequency thermotherapy on benign prostate hyperplasia.

This study aims to evaluate the safety and efficacy of the new bipolar radiofrequency thermotherapy device (TEMPRO) in treating patients with benign prostate hyperplasia (BPH). Between December 2017 and November 2018, 72 male patients with BPH were included. All patients completed the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires. Physical examinations were performed, and prostate volume, prostatic urethral length and post-voiding residual urine (PVR) were measured using ultrasound. Uroflowmetry was used to calculate the maximum flow rate of urination (Qmax). Bipolar radiofrequency thermotherapy was applied with TEMPRO system containing a 16Fr applicator. All patients were re-evaluated at 6 months post-operatively. The mean age of the patients was 63.22 ± 6.68 years. All patients were treated with local anaesthesia, and three patients were unable to complete the procedure. The median (IQR) visual analogue scale score was 1 (0-3) at 6 hr post-operatively. After 6 months, significant improvements were observed in the IPSS, QoL, Qmax and PVR values of the patients (p < .001 for Qmax, IPSS and QoL; p = .03 for PMR). The success rate of the procedure was similar between patients with prostate volumes <70 and >70 ml. Due to its low rate of complication, the TEMPRO© treatment is effective in treating BPH, especially among aged patients and those with serious symptoms.

YouTube as a Source of Information About Premature Ejaculation Treatment.

INTRODUCTION: An increasing number of patients are seeking premature ejaculation (PE) therapy online. Although health care information on the Internet about PE is abundant, the quality of information about its treatment on YouTube, the most visited online video streaming service, is unknown. AIM: The aim of this study was to assess the role of videos pertaining to the treatment of PE through YouTube. METHODS: A cross-sectional study was performed through YouTube using the keywords "cure premature ejaculation," "end premature ejaculation," "stop premature ejaculation," or "premature ejaculation treatment." The videos were sorted as reliable or nonreliable by 2 urologists as they may contain scientifically proven information or not. Nonrelevant, non-English, and silent videos were excluded. Video demographics were analyzed by the quality and source of the video. MAIN OUTCOME MEASURES: A 5-point global quality scale, a 5-point modified reliability (DISCERN) tool, kappa statistic, the intraclass correlation coefficient, and descriptive statistics in the form of proportions and percentages were used. RESULTS: Of the 800 videos, 668 were excluded because they were duplicates (n = 389), irrelevant (n = 49), not in English (n = 284), or had no audio (n = 51). Of the 132 videos, 93 (70%) were described as reliable and 39 (30%) as nonreliable. The kappa statistic for interobserver agreement was 0.832. In the reliable information group, the reliability (2.55 ± 1.03) and quality scores of the contents (2.74 ± 1.06) were statistically higher than those in the nonreliable information group (0.23 ± 0.53 and 1.15 ± 0.48, respectively; P < .05). The majority of the nonreliable information group comprised medical advertisement/for-profit companies (51%) and individuals (41%). There was no significant difference between the reliable and nonreliable information groups in terms of average views (P = .873) and viewed videos per day (P = .538). CLINICAL IMPLICATIONS: Evaluating videos about the management of PE holds promise for understanding what men are exposed to. STRENGTH & LIMITATIONS: The study simultaneously investigated the quality and accuracy of YouTube videos by several aspects using validated instruments. As for limitations, there is no consensus in the literature regarding how to assess health care-related online videos, and the results were not derived from patients' perceptions. CONCLUSION: The study highlights data about the treatment of PE on YouTube. Videos with reliable information outnumbered those with nonreliable information. This is the first study to demonstrate that YouTube is an important source of data on PE management. Physicians and health care providers should contribute reliable content, and YouTube should remove deceptive videos before patients watch them Gul M, Diri MA. YouTube as a Source of Information About Premature Ejaculation Treatment. J Sex Med 2019;16:1734-1740.