Evening type negatively affects semen quality by deteriorating sperm morphology: Results from an infertility clinic.

OBJECTIVE: The effect of sleep-related variables on the reproductive system has garnered attention in recent years. One of the mediators that reportedly plays an important role in the relationship between sleep disorders and the reproductive system is a disruption of the circadian rhythm. The aim of curent study is to investigate the effect of chronotype on morning semen quality. STUDY DESIGN: Three-hundred and fourteen patients who applied to the infertility clinic were included in the study. The patients filled a socio-demographic data form. The "Pittsburg Sleep Quality Index (PSQI) was used to evaluate the sleep quality while the chronotypes of the patients were evaluated with the "Morningness -Eveningness-Questionnaire (MEQ)". Semen analyses and biochemical analysis for testosterone serum plasma level of all patients were performed. RESULTS: Twenty-one patients were assigned as evening, 187 patients were assigned as intermediate, and 106 were assigned as morning chronotype. No statistically significant difference was identified in the comparison of the mean MEQ scores between patients with low and normal sperm concentrations(p = 0.884). A correlation analysis indicated the presence of a significant positive correlation between normal morphology and MEQ scores (r = 0.13, p < 0.05) and a negative corelation between the hours spent in bed and sperm concentration (r = -0.13, p < 0.05). A general linear model created with independent variables suggested that the presence of varicocele and MEQ scores had a significant effect on normal morphology. CONCLUSION: The results of present study support that evening type could negatively affect sperm morphology; additionally, the time spent in bed also negatively affected sperm concentration.

Evaluation of the effect of shift working and sleep quality on semen parameters in men attending infertility clinic.

We aimed to evaluate the effect of shift work on semen parameters together with the effect of sleep quality in men attending infertility clinic. The participants were divided into two groups as follows: 104 shift worker men (Group 1) and 116 nonshift worker men (Group 2). Groups were compared in terms of semen parameters, Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburg Sleep Quality Index (PSQI) scores. A higher rate of oligozoospermia and poor sleep quality and a lower mean normal morphology percentage was observed in shift workers than nonshift workers (p = .006, .039 and .036 respectively). In addition, a positive correlation was seen between sleep duration and sperm concentration, while a negative correlation was found between sleep latency and total sperm count. Shift working together with high PSQI score was also a significant association with oligozoospermia when controlling for the other variables of age, total testosterone, DASS-21 stress score, smoking and varicocele (OR = 2.11, 95% CI 1.03-4.34 and OR = 1.18, 95% CI 1.01-1.39 respectively). In this study, infertile shift workers had a lower percentage of normal morphology and higher rates of oligozoospermia and poor sleep quality. Considering that shift workers have lower sleep quality, it seems that shift working negatively affects the circadian rhythm.

Pre-treatment Delta Neutrophil Index as a Predictive Factor in Renal Cell Carcinoma.

OBJECTIVE: To determine the diagnostic value of the pre-treatment delta neutrophil index (DNI) before treatment in patients with renal cell carcinoma (RCC) and to compare this marker with other routine inflammation markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sutcu Imam University, Turkey, from February 2017 to January 2020. METHODOLOGY: Data of patients who underwent radical nephrectomy for RCC, were evaluated. For comparison, healthy individuals were included in the study as a control group. Demographic data, such as age, gender, routine laboratory tests, DNI, NLR, and PLR levels of the groups were recorded and compared. RESULTS: There were 73 patients in the RCC group and 71 healthy individuals in the control group. DNI, NLR and PLR levels were significantly higher in the RCC group (p <0.001, each). DNI and NLR were significantly higher in patients with advanced stage (T3-T4) and high grade (G3-G4). In univariate logistic regression analysis hemoglobin (p=0.023), neutrophil (p<0.001), lymphocyte (p=0.009), platelet (p<0.001), DNI (p<0.001), NLR (p<0.001) and PLR (p<0.001) were identified as predictors for RCC. In multivariate logistic regression analysis, DNI and NLR (p<0.001, each) were found to be the predictors of RCC. Cut-off values were 0.45% for DNI, 1.80 for NLR, and 130.09 for PLR. CONCLUSION: DNI is a new inflammatory marker, which is included in complete blood count parameters; and does not require any additional calculation, unlike NLR and PLR. It can be used in the prediction of RCC. Key Words: Renal cell carcinoma, Delta neutrophil index, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio.

At What Age Threshold does the Decline in Semen Parameters Begin?

OBJECTIVE:  To analyse changes in semen parameters according to different age groups in men presenting to an infertility clinic, and determine the age threshold for decline in semen quality. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Andrology Laboratory, Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from January 2018 to December 2019. METHODOLOGY: Semen analysis records of infertile men, who were referred to Andrology Laboratory, were retrospectively evaluated. The age groups were categorised as 20-29, 30-34, 35-39, 40-44, and 45-55 years. Each group was completed to 100 semen samples retrospectively and sequentially without any preferences. The differences of semen parameters between age groups were analysed with the one-way ANOVA test. Linear relationship was checked by ANOVA. RESULTS: The mean age of 500 patients was 37.18 ± 8.11 years. While no linear relationship was observed in semen volume, concentration, and total sperm count with age (p=0.133, p=0.290 and p=0.261, respectively). A linear decline was observed in progressive motility, vitality, and morphology parameters with advancing age (all, p<0.001). In linear contrast analysis according to the 20-29 age group; significant decline in progressive sperm motility, morphology, and vitality started and continued in the 35-39 age group (all, p<0.001). CONCLUSION: With advancing age, a significant linear decrease in sperm motility, morphology and vitality was observed in infertile men. This significant decline in sperm motility, morphology and vitality continues at age 35 and over. Therefore, infertile men who plan to postpone paternity should consider the age factor. Key Words: Aging, infertility, Paternal age, Semen analysis, Sperm.

The Delta Neutrophil Index is an Early Predictive Marker of Acute Pyelonephritis in Patients with Ureteral Stone.

OBJECTIVE: To determine the predictive value of the delta neutrophil index (DNI) for acute pyelonephritis (APN), which increases in conditions of infection and inflammation. STUDY DESIGN: Observational, comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from December 2014 to November 2019. METHODOLOGY: The data of 205 patients, diagnosed with ureteral stone and urinary tract infection (UTI), were evaluated. For comparison, patients were categorised into two groups: those with lower UTI (LUTI) and those with APN. Together with demographic data of patients and ureteral stone, DNI, C-reactive protein (CRP), white blood cell (WBC) and other biochemical parameters were analysed. RESULTS: There were 165 patients (80.5%) in the LUTI group and 40 patients (19.5%) in the APN group. In univariate analysis, age (p=0.023), creatinine (p=0.001), PT/INR (p=0.007), WBC (p <0.001), CRP (p=0.002) and DNI (p <0.001) were identified as predictors of APN. In multivariate analysis, CRP (p=0.019) and DNI (p=0.009) were significantly associated with the predictors of APN. Cut-off values were 11.75 mm3 for WBC, 22.2 mg/dL for CRP, and 1.3% for DNI. DNI value was positively correlated with WBC and CRP (r=0.369 vs. 0.740 and p <0.001, each). CONCLUSION: As an infection marker that can be monitored with a complete blood count and does not require additional costs, DNI can be used as an early predictor of APN. Patients with a DNI value of >1.3% should be considered for early intervention. Key Words: Ureteral stone, Acute pyelonephritis, Delta neutrophil index, C-reactive protein, White blood cell.

Relationship between the G protein-coupled oestrogen receptor and spermatogenesis, and its correlation with male infertility.

The aim of this study was to investigate the diagnostic value of serum G protein-coupled oestrogen receptor (GPER) levels and their correlation with semen parameters in men with infertility. The participants were divided into two groups as follows: 76 fertile control men (Group 1) and 77 infertile men (Group 2). Semen analysis, hormonal evaluation, serum GPER level and scrotal ultrasound of the participants were evaluated. Follicle-stimulating hormone and total testosterone levels were not significantly different between the groups (p = .413 and p = .535 respectively). The oestradiol level in Group 1 was significantly lower than that in Group 2 (p < .001). The serum GPER level was found to be significantly higher in Group 1 than that of Group 2 (p < .001). GPER levels were positively correlated with the total sperm count, sperm concentration, motility and morphology in Group 2 (r = 0.303, 0.345, 0.260 and 0.322, respectively, p < .001). In this study, GPER levels were positively correlated with sperm parameters, and it was hypothesised that the decrease in GPER expression might be associated with male infertility by adversely affecting spermatogenesis.

Ziziphus jujube ameliorated cavernosal oxidative stress and fibrotic processes in cavernous nerve injury-induced erectile dysfunction in a rat model.

The aim of this study was to investigate potential antioxidant and antifibrotic effects of Ziziphus jujube (ZJ) in a cavernosal nerve injury (CNI)-induced erectile dysfunction (ED) rat model. Forty-eight male rats were assigned to six-sized groups as group 1: sham-operated; group 2: sham-operated + low-dose ZJ (200 mg/kg); group 3: sham-operated + high-dose ZJ (400 mg/kg); group 4: CNI + distilled water; group 5: CNI + low-dose ZJ; and group 6: CNI + high-dose ZJ. At the end of 2 weeks, intracardiac blood was taken and rats were sacrificed. For biochemical analysis, cavernosal transforming growth factor-beta-1, collagen type I and type 3, fibronectin, α and ß actin were examined in plasma and cavernosa. Superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and prolidase levels were measured in serum to evaluate antioxidant effect of ZJ. Histopathological examination of tissues revealed that highest fibrosis rate was in group 4 (66.84%). Collagen 1 and 3, alpha and beta actin, fibronectin levels were significantly different among groups (p < .05). Differences between plasma SOD, CAT, MDA and prolidase were also significant among those groups (p < .05). In this study, antioxidant and antifibrotic effects of ZJ were determined in the corporal tissue after CNI. It is thought that ZJ may be beneficial on ED patients especially after radical pelvic surgeries.

Losartan treatment significantly attenuates the fibrotic changes in the corpus cavernosum of castrated rats / El tratamiento con losartán atenúa de manera importante los cambios fibróticos en el cuerpo cavernoso de ratas castradas

INTRODUCTION AND OBJECTIVES: The aim of this study is to evaluate the effects of castration and subsequent losartan administration on the fibrosis-related parameters in the corpora cavernosa of castrated rats. MATERIAL AND METHODS: Twenty-four male rats were divided into four equal groups. Group 1:sham surgery plus vehicle (0.9% NaCl) (control:con), group 2:sham surgery plus losartan (con+los), group 3: castration plus vehicle (castration:cast) and group 4:castration plus losartan (cast+los). After four weeks of oral losartan treatment, corporal levels of transforming growth factor-beta (TGF-beta), thrombospondin-1 (TSP-1), alpha-actin, beta-actin and fibronectin were investigated by ELISA kits. Changes in the collagen and smooth muscle content were evaluated by histological analysis with Masson trichrome staining. RESULTS: Initial and post-treatment body weights of rats were similar among groups. Castration significantly increased the expression of TGF-beta, TSP-1 and fibronectin and resulted in a significant decrease in alpha-actin levels in the corpora cavernosa. Administration of losartan reduced the levels of TGF-beta, TSP-1 and fibronectin in castrated rats. Alpha actin levels also increased after losartan treatment. Beta-actin levels were not significantly different among 4 groups. The levels of all markers were similar in group 1 and 2. Rate of fibrosis was significantly higher in castrated rats and treatment with losartan reduced this rate. CONCLUSION: Castration increased the expression of fibrosis-related markers in the corpora cavernosa of rats. Administration of losartan significantly attenuated those changes and exerted an antifibrotic effect

INTRODUCCIÓN Y OBJETIVOS: El objetivo de este estudio es evaluar los efectos de la castración y la posterior administración de losartán en los parámetros relacionados con la fibrosis en los cuerpos cavernosos de ratas castradas. MATERIAL Y MÉTODOS: Veinticuatro ratas macho se dividieron en 4 grupos iguales. Grupo 1: cirugía simulada más vehículo (0,9% NaCl) (control:con); grupo 2: cirugía simulada más losartán (con+los); grupo 3: castración más vehículo (castración:cast) y grupo 4: castración más losartán (cast+los). Después de 4 semanas de tratamiento oral con losartán se analizaron los niveles de factor de crecimiento transformante beta (TGF-beta), trombospondina-1 (TSP-1), alfa-actina, beta-actina y fibronectina mediante kits de ELISA. Cambios en el colágeno y el contenido de músculo liso se evaluaron mediante análisis histológico con tinción con tricrómico de Masson. RESULTADOS: Los pesos corporales iniciales y posteriores al tratamiento de las ratas fueron similares entre los grupos. La castración aumentó considerablemente la expresión de TGF-beta, TSP-1 y fibronectina, y dio como resultado una disminución importante de los niveles de alfa-actina en los cuerpos cavernosos. La administración de losartán redujo los niveles de TGF-beta, TSP-1 y fibronectina en ratas castradas. Los niveles de alfa-actina también aumentaron después del tratamiento con losartán. Los niveles de beta-actina no fueron muy diferentes entre los 4 grupos. Los niveles de todos los marcadores fueron similares en los grupos 1 y 2. La tasa de fibrosis fue mucho mayor en las ratas castradas y el tratamiento con losartán redujo esta tasa. CONCLUSIÓN: La castración aumentó la expresión de marcadores relacionados con la fibrosis en los cuerpos cavernosos de las ratas. La administración de losartán atenuó considerablemente esos cambios y ejerció un efecto antifibrótico

Losartan treatment significantly attenuates the fibrotic changes in the corpus cavernosum of castrated rats.

INTRODUCTION AND OBJECTIVES: The aim of this study is to evaluate the effects of castration and subsequent losartan administration on the fibrosis-related parameters in the corpora cavernosa of castrated rats. MATERIAL AND METHODS: Twenty-four male rats were divided into four equal groups. Group 1:sham surgery plus vehicle (0.9% NaCl) (control:con), group 2:sham surgery plus losartan (con+los), group 3: castration plus vehicle (castration:cast) and group 4:castration plus losartan (cast+los). After four weeks of oral losartan treatment, corporal levels of transforming growth factor-beta (TGF-ß), thrombospondin-1 (TSP-1), alpha-actin, beta-actin and fibronectin were investigated by ELISA kits. Changes in the collagen and smooth muscle content were evaluated by histological analysis with Masson trichrome staining. RESULTS: Initial and post-treatment body weights of rats were similar among groups. Castration significantly increased the expression of TGF-ß, TSP-1 and fibronectin and resulted in a significant decrease in alpha-actin levels in the corpora cavernosa. Administration of losartan reduced the levels of TGF-ß, TSP-1 and fibronectin in castrated rats. Alpha actin levels also increased after losartan treatment. Beta-actin levels were not significantly different among 4 groups. The levels of all markers were similar in group 1 and 2. Rate of fibrosis was significantly higher in castrated rats and treatment with losartan reduced this rate. CONCLUSION: Castration increased the expression of fibrosis-related markers in the corpora cavernosa of rats. Administration of losartan significantly attenuated those changes and exerted an antifibrotic effect.

Sexual dysfunction and distress in premenopausal women with migraine: association with depression, anxiety and migraine-related disability.

Migraine is a chronic disorder associated with impaired quality of life as well as sexual function. However, data about the sexual distress in women with migraine were lacked.This study aimed to determine the incidence and associated risk factors of both sexual function and distress in premenopausal women with migraine. Sixty-nine women diagnosed with migraine were included. Sexual function and distress were assessed by Female sexual function index (FSFI) and Female sexual distress scale-revised (FSDS-R), respectively. Depression and anxiety were investigated by Hospital depression and anxiety scale (HADS). Migraine related disability was evaluated by Migraine disability assessment scale (MIDAS) and average severity of pain was determied by Visual analog scale (VAS). Fifty-five women reported to have sexual dysfunction. Any headache-related feature including MIDAS and VAS scores, depression or anxiety was found to be related with sexual dysfunction. Sexual distress was noted in 37 cases, and depression, VAS and MIDAS scores were significantly higher in women with sexual distress. This study showed that women with migraine should be screened both for sexual dysfunction and distress to help clinicians dealing with sexual medicine to improve the standart of patient care in their regular practice. Special attention should be given to the ones whose MIDAS and VAS scores were high and who had depression.

Giant renal metastasis from prostate cancer mimicking renal cell carcinoma.

The most common sites for prostate cancer metastasis include bone, distant lymph nodes, liver and lungs. Renal metastasis of prostate cancer is a rarely seen pattern of invasion. In the current study, we described an 83-year-old male with a history of prostate cancer. He was admitted because of edema, hyperemia, warm and pain at left leg and inguinal region. In the further evaluation, a mass lesion at prostate region and conglomerate lymphadenopathy at left iliac vascular trajectory and a mass lesion at left kidney with heterogeneous contrast-enhancement were observed on contrast-enhanced magnetic resonance imaging and computerized tomography scan. Fine-needle aspiration biopsy was performed in the lesion with radiologically suspect renal cell carcinoma. By evaluating histopathological features and immunohistochemical staining of the tumor, we decided that the lesion was metastasis from prostate cancer.

Ureteroscopy With Holmium:Yag Laser Lithotripsy for Ureteral Stones in Preschool Children: Analysis of the Factors Affecting the Complications and Success.

OBJECTIVE: To evaluate the factors that may affect the efficacy and safety of ureteroscopy with holmium:YAG laser lithotripsy in the management of ureteral stones in preschool children. MATERIALS AND METHODS: Medical records of 70 children, 32 boys and 38 girls, who were treated for ureteral stones at our clinic between 2014 and 2016 were retrospectively reviewed. Patients were grouped according to size of the instrument used as group 1 (n = 40, ultrathin 4.5 Fr) and group 2 (n = 30, 7.5 Fr). Patient age, stone characteristics, and operative and postoperative outcomes were compared. The effect of age, stone size and location, type of the instrument, and operative times on success and complication rates were also investigated. In addition, factors related with postoperative hydronephrosis were evaluated. RESULTS: Patients in group 1 were significantly younger than group 2 (32.22 ± 22.72 vs 63.53 ± 16.98 months, P = .000). Groups were similar in terms of gender, stone laterality, size and location, and operative times. However, access failure rate was significantly higher in group 2 (0 vs 20%, P = .022). Stone-free rate was 87.5% in group 1 and 76.6% in group 2 (P = .237), complication rates were not significantly different among groups. Stone size and location were found to be associated with success rates. Stone location and operative times were the factors affecting the complication rates. Presence of preoperative hydronephrosis and prolonged operative time were determined as the predictors of postoperative hydronephrosis. CONCLUSION: Ultrathin ureteroscopy with laser lithotripsy can be used safely and effectively for ureteral calculi including proximal ones in significantly younger children without any access failure.

Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction.

INTRODUCTION: Erectile dysfunction (ED) and cardiovascular (CV) diseases share common risk factors and ED has been accepted as an early manifestation of CV disease. Exercise stress testing (EST) is used to evaluate CV functions in men with ED. Low exercise workload, a slower heart rate recovery (HRR) after exercise, and inability to increase heart rate during EST (chronotropic incompetence) are independent negative predictors of adverse CV outcomes. AIM: To assess the association among EST parameters, ED, and testosterone levels. METHODS: The study population consisted of 41 patients with ED and 40 controls. All participants underwent treadmill EST to assess cardiac autonomic functions. HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2), and 3rd (HRR3) minute heart rates during the recovery period from maximal heart rate. Total exercise duration, exercise capacity and chronotropic response, and plasma testosterone levels were evaluated. Erectile functions were evaluated with the Sexual Health Inventory for Men. Patients were divided into subgroups according to severity and duration of ED. MAIN OUTCOME MEASURES: Mean HRR1 (30.6 ± 11.9 vs 36.9 ± 9.9; P = .01), HRR2 (44.9 ± 12.4 vs 54.9 ± 7.8; P < .001), and HRR3 (50.1 ± 11.7 vs 63.0 ± 7.9; P < .001) were significantly lower in the ED than in the control group. Total exercise duration (9.4 ± 1.9 vs 10.9 ± 1.7 minutes; P < .001), exercise capacity (12.5 ± 1.9 vs 13.6 ± 1.4 metabolic equivalents; P = .004), and chronotropic response (0.88 ± 0.1 vs 1.0 ± 0.1; P < .001) were worse in the ED group. However, we found no association between severity and duration of ED and EST parameters. In addition, serum testosterone levels were significantly correlated with HRR1 (r = 0.36, P = .02) in men with ED. CONCLUSION: Our data suggested that cardiac autonomic functions are impaired in patients with ED. A weak correlation between cardiac autonomic dysfunction and low testosterone levels in patients with ED was noted. However, further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions and testosterone replacement therapy in patients with ED. Kucukdurmaz F, Agar G, Resim S. Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction. Sex Med 2018;6:8-14.

Evaluation of serum prolidase activity and oxidative stress markers in men with BPH and prostate cancer.

BACKGROUND: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are diseases of elderly men and are related to increased oxidative stress (OS). Although prolidase has a role in collagen metabolism, it is also used to evaluate OS in many diseases. However, there is a lack of data about serum prolidase activity (SPA) in prostate cancer. The aim of this study was to evaluate and compare SPA levels in males with BPH and PCa. METHODS: Evaluation was made of a total of 81 men who underwent transrectal ultrasound guided prostate biopsy for a definitive diagnosis due to high PSA levels. Patients were separated into 2 groups as BPH and PCa patients. Pre-biopsy malondialdehyde (MDA), superoxide dismutase (SOD), PSA levels and serum prolidase activities (SPA) were compared between the groups and the correlations of SPA with the other parameters were also investigated in both groups. RESULTS: BPH was diagnosed in 51 patients and PCa in 30. The mean age of patients was similar in both groups as 63.25 ± 5.81 years in the BPH group 65.30 ± 7.35 years in the PCa group(p:0.081). The median MDA and SOD levels were insignificantly increased in the PCa patients. SPA values were similar in BPH and PCa patients. SPA did not correlate with age, PSA, MDA or SOD levels in either group. CONCLUSIONS: Our study results revealed that serum prolidase activity is similar in BPH and PCa cases and is not correlated with MDA, SOD or PSA levels.

Evaluation of the diagnostic efficacy of strain elastography in infertile population with normal and abnormal semen parameters.

OBJECTIVE: The aim of the present study was to investigate the diagnostic value of strain elastography (SE) of testicular tissues in infertile population. We also evaluated the correlation between SE results with semen parameters and hormone profiles of the patients. MATERIAL AND METHODS: A total of 61 patients and 122 testes were evaluated. Patients who were evaluated in an andrology outpatient clinic with the diagnosis of infertility and referred to radiology department for investigation of reproductive organs between June 2015 and January 2016 were included. Patients were divided into two groups according to semen analyses results as normal (Group 1) and abnormal (Group 2). Hormone profiles, semen analyses, B-mode, coloured Doppler ultrasonography and sonoelastography examinations were performed for each patient. Measurements of testicular volumes, resistive indices (RI) in intraparenchymal arteries, strain, strain ratio (SR) and presence of varicocele were recorded. RESULTS: Mean age of participants was 33.7±6.3 years. Mean testicular volumes (Group 1, 19.41±4.8 mL, and Group 2, 17.64±3.62 mL) were significantly different between groups (p=0.023). Mean SRs were also different between Groups 1 and 2 (0.12±0.08 vs. 0.22±0.18, p<0.001). Testicular volumes were directly proportional with SRs in Group 1. Strain values had inverse relationship with sperm concentration and total motile sperm counts in Group 2 (p=0.01). SRs were found to be positively correlated with RI and sperm morphology in Group 2 (p<0.05). Although FSH values showed significant difference among groups, any correlation between FSH and elastographic parameters could not be displayed. CONCLUSION: Strain elastography results were found to be significantly different in patients with abnormal sperm counts. This technique may provide promising results, however, further large scale studies may help to clarify the value of this imaging modality in the assessment of male infertility.

Prevalence and correlates of female sexual dysfunction among Turkish pregnant women.

OBJECTIVE: The aim of the present study was to determine the prevalence and associated factors of female sexual dysfunction together with the concerns of women about sexuality during pregnancy. MATERIAL AND METHODS: A total of 207 healthy, sexually active pregnant women were enrolled in the study. Demographic data of all participants were noted and sexual functions were evaluated by Female Sexual Function Index (FSFI). Each FSFI domain score was calculated and mean scores were noted. Concerns of women about sexuality were also investigated. RESULTS: Mean age of participant women was 27.0±5.9 (range 15-44) years. Prevalence of sexual dysfunction was found to be 87% in study population. Mean FSFI score was 18.6±1.21. The rate of sexual dysfunction was higher in the first (87%) and third (92.6%) trimesters when compared to the second (80.6%) trimester (p=0.243). Among demographic variables, education levels of partners and preconceptional sexual dysfunction were found to be significantly related to FSD. The most common concerns of women about sexual relationship have been reported as the fear of having pain (35%), risk of abortion (21.3%) and religious factors (10%). CONCLUSION: Prevalence of sexual dysfunction is relatively high among pregnant women. Educational levels and preconceptional sexual functions were found to have an impact on this high rate. Accurate counseling of partners about sexuality during pregnancy may help to reduce misbeliefs, concerns and, thereby, decrease this high rate of female sexual dysfunction.

A Comparison of Sexual Function, Psychological Status, and Sociodemographic Characteristics of Turkish Men within Polygamous and Monogamous Marriages.

BACKGROUND: A limited number of studies within the literature have entailed objective evaluations of psychological, sexual, and emotional features of women within polygamous marriages. However, there is a lack of studies reporting these features among polygamous and monogamous men. AIMS: The aim of this study was to investigate sociodemographic characteristics, sexual function, and psychological status of polygamously and monogamously married men. STUDY DESIGN: Cross-sectional study. METHODS: The study sample comprised two groups: 35 polygamous and 45 monogamous men in Kahramanmaras Province, Turkey. Door-to-door surveys covered sociodemographic factors and adopted Beck Depression Inventory (BDI), and International Index of Erectile Function - Erectile Function Domain (IIEF-EFD) scales. RESULTS: Polygamous men showed considerably higher IIEF-EFD scores (p<0.05). While the median score of IIEF-EFD was 25.0 for polygamous men, it was 22.0 for monogamous men. A comparison of the two groups revealed that polygamous men had lower BDI scores. However, the difference between the groups was statistically non-significant (p>0.05). Odds ratios and 95% confidence intervals of monogamous men for erectile dysfunction and depression were 14.4 (95% CI: 3.1-67.5) and 7.4 (95% CI: 0.9-61.9), respectively. The main reasons for multiple marriages reported by polygamous men, in descending order, were: 1) decreased satisfaction of sexual desires by a wife (37.1%); 2) falling in love with the second wife (22.8%); and 3) incompatibility with the first wife (17.1%). However, 62.9% of them responded negatively to the question: "Would you recommend polygamous marriage to other men?" CONCLUSION: Our results showed that polygamous men had higher erectile function and lower depression scores than monogamous men. Further studies investigating the effects of polygamy on men's psychosexual function are warranted. Additionally, studies that address the perspectives of offspring and women's expectations within polygamous marriages should be conducted.

Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women.

OBJECTIVES: Female sexual dysfunction (FSD) and urinary incontinence (UI) are associated risk factors that might cause each other. No study has investigated prevalence of FSD and UI in the same population. The aims of the study were to investigate the prevalence of FSD and UI and associated risk factors in the same population. STUDY DESIGN: The study included 1217 women in 20 provinces, representing the geographical regions of Turkey. Women aged ≥18 years with active sexual life in the last 6 months were enrolled. FSD, overactive bladder, UI, depression, and sexual distress were investigated using validated scales. Risk factors that might predict FSD and UI were determined in the same population. RESULTS: The prevalence of FSD and UI was 52.5% and 14.6%, respectively. Comparing the women with and without FSD, those with FSD were older, had higher body mass index (BMI), less physical exercise, older spouses, lower educational level, and lower rates of smoking and alcohol consumption. The rates of women in menopause and those with a spouse/partner having erection problem and the rates of UI, depression, and sexual distress were higher in the FSD group. Age of spouse, low educational level, not smoking, not consuming alcohol, menopause, not giving consent to spouse/partner to use sexual performance-enhancing drugs when necessary, depression, and sexual distress were the significant risk factors for FSD. Of the women with UI, 56% had overactive bladder symptoms, 32% had stress UI, and 12% had mixed type UI. Comparing the women with and without UI, those with UI were older, had higher BMI, lower educational level, and older spouses. The rate of menopausal women and the rates of FSD, depression, and sexual distress were higher in the UI group. Menopause and FSD were the significant risk factors for UI. CONCLUSIONS: This is the first study to investigate prevalence of FSD and UI in the same population. UI deteriorates sexual functions of women. Therefore, both conditions should be assessed when women complain of either sexual or urinary problems.

Cognitive, Affective Problems and Renal Cross Ectopy in a Patient with 48,XXYY/47,XYY Syndrome.

Klinefelter syndrome is the most common sex chromosome abnormality (SCA) in infertile patients and 47,XXY genomic configuration constitutes most of the cases. However, additional Xs and/or Y such as 48,XXYY, 48,XXXY, and 47,XYY can occur less frequently than 47,XXY. Those configurations were considered as variants of Klinefelter syndrome. In this report, we present an infertile man with tall stature and decreased testicular volume. Semen analysis and hormonal evaluation supported the diagnosis of nonobstructive azoospermia. Genetic investigation demonstrated an abnormal male karyotype with two X chromosomes and two Y chromosomes consistent with 48,XXYY(17)/47,XYY (13). Additionally, the patient expressed cognitive and affective problems which were documented by psychomotor retardation and borderline intelligence measured by an IQ value between 70 and 80. Systemic evaluation also revealed cross ectopy and malrotation of the right kidney in the patient. The couple was referred to microtesticular sperm extraction (micro-TESE)/intracytoplasmic sperm injection (ICSI) cycles and preimplantation genetic diagnosis (PGD). To the best of our knowledge, this is the first report of combination of XYY and XXYY syndromes associated with cognitive, affective dysfunction and renal malrotation.

Does imprint cytology improve the accuracy of transrectal prostate needle biopsy?

OBJECTIVE: To evaluate the accuracy of imprint cytology of core needle biopsy specimens in the diagnosis of prostate cancer. METHODS: Between December 24, 2011 and May 9, 2013, patients with an abnormal DRE and/or serum PSA level of >2.5 ng/mL underwent transrectal prostate needle biopsy. Samples with positive imprint cytology but negative initial histologic exam underwent repeat sectioning and histological examination. RESULTS: 1,262 transrectal prostate needle biopsy specimens were evaluated from 100 patients. Malignant imprint cytology was found in 236 specimens (18.7%), 197 (15.6%) of which were confirmed by histologic examination, giving an initial 3.1% (n = 39) rate of discrepant results by imprint cytology. Upon repeat sectioning and histologic examination of these 39 biopsy samples, 14 (1.1% of the original specimens) were then diagnosed as malignant, 3 (0.2%) as atypical small acinar proliferation (ASAP), and 5 (0.4%) as high-grade prostatic intraepithelial neoplasia (HGPIN). Overall, 964 (76.4%) specimens were negative for malignancy by imprint cytology. Seven (0.6%) specimens were benign by cytology but malignant cells were found on histological evaluation. On imprint cytology examination, nonmalignant but abnormal findings were seen in 62 specimens (4.9%). These were all due to benign processes. After reexamination, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate of imprint preparations were 98.1, 96.9, 98.4, 92.8, 99.3, 1.6, 3.1%, respectively. CONCLUSION: Imprint cytology is valuable tool for evaluating TRUS-guided core needle biopsy specimens from the prostate. Use of imprint cytology in combination with histopathology increases diagnostic accuracy when compared with histopathologic assessment alone.