The complementary role of different neurophysiological methods to demonstrate organicity in male with premature ejaculation and erectile dysfunction.

Erectile dysfunction and premature ejaculation are the most common male sexual disorders. Generally, it is considered that erectile dysfunction is related to organic factors whilst premature ejaculation is related to psychological factors. A detailed history along with physical examination such as using penile doppler, penile tumesans and ultrasonography are insufficient for differential diagnosis in 15-20% of cases. Therefore the role of neurophysiological techniques are important. In this study urological and biochemical investigations were used in conjunction with other neurophysiological methods. According to our results, using a neurophysiological test study on its own was ineffective. As a conclusion our study has shown that neurophysiological methods are important differential diagnosis of revealing suspicious organicity--generally believed to be due to psychological factors- in male sexual disorders.

Free and total prostate-specific antigen levels in saliva and the comparison with serum levels in men.

OBJECTIVE: We investigated free and total prostate-specific antigen (PSA) levels and free/total (f/t) ratio in the fasting saliva and compared them with the serum levels in normal individuals, in patients with benign prostatic hyperplasia (BPH) and prostate cancer. Our aim was to determine free and total PSA and f/t ratio in saliva and to improve and simplify the differentiation between BPH and prostate cancer by using saliva as an alternative to serum. METHODS: Serum and fasting saliva concentrations of free and total PSA were measured in 35 men with BPH, 16 men with stage D prostate cancer, and 25 healthy men. Serum and fasting saliva samples were collected at the same time and were analyzed on the same day at our laboratory with microparticle enzyme immunoassay technology. RESULTS: For the total of 76 men, there was a significant correlation between free and total PSA levels in each sample (r = 0.97 for serum and r = 0.44 for saliva, p<0.001). Although there was a significant difference between three groups for serum-free and total PSA levels and serum f/t ratios, no significant difference was determined between groups for salivary free and total PSA levels and salivary f/t ratios. No correlations were found between patient age and salivary PSA levels. CONCLUSIONS: Fasting salivary free and total PSA levels are not effected by high serum levels of prostatic origin. Although there was a significant difference between mean serum and salivary levels of free and total PSA in each group, the f/t ratio of saliva was very close to the serum ratio of normal subjects. Determination of free and total PSA in saliva to improve and simplify the differentiation between prostate cancer and BPH is not suitable for use as alternative measurement of serum.

Renal tubular apoptosis after complete ureteral obstruction in the presence of hyperoxaluria.

Hyperoxaluria is a well-known cause of renal stone disease and in vitro studies have shown that oxalate crystals have a stimulatory effect on apoptosis of renal tubular epithelial cells. Total and partial ureteral obstruction also have an accelerating effect on apoptosis of renal tubular epithelial cells. The aim of the present study was to investigate the apoptotic effect of unilateral ureteral obstruction in the presence of hyperoxaluria on the rat kidney. Twenty-eight male Wistar rats were divided into four groups, with seven rats in each. The groups were named G1 (control), G2 (hyperoxaluric), G3 (obstructive) and G4 (hyperoxaluric + obstructive). G2 and G4 rats were given 1% ethylene glycol (a precursor for oxalates) in their drinking water. G1 and G2 rats underwent sham operation, while left proximal ureteral ligation with a 5-zero silk suture was performed on G3 and G4 animals. The rats were sacrificed 2 weeks after the operation; left nephrectomy was then performed. We searched for the apoptotic cells by direct immuno-peroxidase detection of digoxigenin-labeled genomic DNA. The mean +/- SD values of the apoptotic cell count was 0.86+/-0.90 in G1 and 4.33+/-3.81 in G2. The values for G3 and G4 were 30.17+/-16.85 and 302.67+/-184.45, respectively. We found a statistically significant difference between all groups (P < 0.001). When compared with the control group (G1), the mean apoptotic cell count was fivefold that of G2 and 35- and 351-fold those of G3 and G4, respectively. Our study demonstrated that hyperoxaluria with complete ureteral obstruction induces an excessive level of apoptosis, which is responsible for renal damage, and that ureteral obstruction is a more important factor for apoptosis than hyperoxaluria. Considering these data, we also believe that research studies for medical preventive measures must be considered for patients with ureteral obstruction and/or hyperoxaluria.

Prostate electromyography: a new concept.

Knowledge of the pharmacological and electrophysiological properties of prostatic smooth and striated muscle myofibres are necessary in order to determine whether the dynamic component of benign prostatic hyperplasia (BPH). To our knowledge prostate electromyography have not previously been applied in any type of prostate disorder. The purpose of the present study is to evaluate the electrical activity of the prostatic muscle fibers. We were able to evaluate the features of prostatic muscle action potentials (PMAP) in 15 of the 16 patients from the area around the prostate capsule. Prostate was palpated in the knee-chest position then concentric needle electrode was inserted into the prostate tissue under digital guidance. Needle tip position in the prostate was confirmed with transabdominal ultrasonography. PMAPs were analysed with multi-motor unit action potential analysis (MMA) algorithm. Whenever the PMAPs were unsuitable for analysing with MMA software the amplitude trigger line method was used. Further studies with a large number of patients are needed to establish the correlation between the electrical activity of prostatic muscle fibers and dynamic component of patients with symptomatic BPH.

The management of vesical calculi with combined optical mechanical cystolithotripsy and transurethral prostatectomy: is it safe and effective?

OBJECTIVES: To investigate the effectiveness and reliability of the combination of optical mechanical cystolithotripsy (OMC) and transurethral prostatectomy (TURP) for the treatment of bladder calculi and obstructive benign prostatic enlargement (BPE). PATIENTS AND METHODS: From December 1990 to December 1996, 61 patients who had bladder stones and BPE or bladder neck contracture were treated with combined OMC and TURP; 32 patients who had bladder stones with no infravesical obstruction were treated with OMC alone. The records of a random selection of 97 patients with obstructive BPE who were treated with TURP only in the same period were used as the control. The operative duration time, the length of hospital stay, the duration of urethral catheterization, outcome and complications of the procedures for each patients were reviewed. The Mann-Whitney U-test and chi-square tests were used for statistical analysis. RESULTS: The mean duration of surgery, hospital stay and urethral catheterization were significantly longer with combined OMC and TURP than with OMC alone (P<0.05). Stone-free rates were 94% after OMC alone and 93% after combined OMC and TURP. The postoperative mean peak flow rates were 14.3 mL/s after the combined procedure and 15.2 mL/s after TURP alone. The complication rates were 21% for the combined procedure and 13% for OMC alone. The complication rate of TURP was 5%, significantly lower than that for the combined procedure (P<0.05). CONCLUSION: Bladder stones were associated with infravesical obstruction in two-thirds of patients. Simultaneous treatment with OMC and TURP did not change the effectiveness of these procedures, but caused additional morbidity.

Requirement of analgesia for extracorporeal shock wave lithotripsy and efficacy of a nonsteroidal antiinflammatory drug: piroxicam.

OBJECTIVE: In this study, the requirement of analgesia and the analgesic efficacy of a long-acting nonsteroidal antiinflammatory drug (NSAID), piroxicam, were investigated in patients with renal stone disease treated with extracorporeal shock wave lithotripsy (ESWL). METHODS: This randomized, placebo-controlled study included 60 patients. Patients were divided into two groups randomly. A single dose of saline (2 ml) was given to the patients in group 1 (n = 20) and 2 ml of 40 mg piroxicam to the patients in group 2 (n = 40). All injections were administered into the gluteal muscle 45 min before ESWL. A verbal rating scale (VRS) was used to evaluate the pain. Groups were compared according to age, sex, weight, height, stone size, number of shock waves, duration of ESWL and VRS scores. RESULTS: There was no statistically significant difference between both groups in demographic data, stone size, number of shock waves and duration of ESWL procedure (p > 0.05). However mean VRS scores were significantly lower in group 2 than in group 1 during and after the ESWL procedure. CONCLUSION: We considered that analgesic agents should be used to control the pain in second-generation lithotriptors. Piroxicam has clinically significant effects on the pain and also antiinflammatory effects, inhibits ureteric activity, and helps in stone passage.

Cytoprotective effect of trimetazidine on 75 min warm renal ischemia-reperfusion injury in rats.

In this experimental study, we evaluated the effect of trimetazidine (TMZ) on renal ischemia-reperfusion (IR) injury in Sprague-Dawley rats. Renal IR was achieved by a 75-min clamping of the left renal pedicle and subsequent 24 h reperfusion, after right nephrectomy was performed. The rats were randomly divided into three groups: group 1 (sham-operated: no IR injury), group 2 (ischemic control: saline treatment), and group 3 (3 mg/kg TMZ before ischemia). After 24 h of reperfusion, blood samples and renal tissue samples were taken to measure the levels of creatinine, tissue malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) activity. Histopathological changes were evaluated. In addition, the 7-day survival rates in each group were evaluated. We found significant increases in the levels of creatinine and tissue MDA, severe acute tubular necrosis, and a significant decrease in the activity of the GSH-Px in group 2. There were significant decreases in the levels of creatinine and tissue MDA, mild acute tubular necrosis, and a significant increase in activity of the GSH-Px in group 3 when compared with the control group (p <0.05). Statistically significant differences (p <0.05) in survival were noted between the ischemic control and sham-operated and TMZ groups. We have concluded that TMZ is able to protect the kidney from warm IR injury.

The effect of L-arginine and pentoxifylline on postoperative adhesion formation.

BACKGROUND: Postoperative intraperitoneal adhesion formation is a major cause of infertility, pain, intestinal obstruction, and subsequent intraoperative complication. We investigated the effects of L-arginine and pentoxifylline for preventing postoperative adhesion in rats. METHODS: Forty Sprague-Dawley rats were subjected to a standardized lesion by serosal trauma of the uterine horn and parietal peritoneal defect. The agents were administered intraperitoneally at the end of surgery. The rats were assigned randomly into control (saline treated), L-arginine, pentoxifylline and L-arginine with pentoxifylline groups. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. The data were analyzed by Mann Whitney U test. RESULTS: In L-arginine and pentoxifylline administered groups, adhesion formation scores were significantly lower than the control group (p<0.05). However, the efficacy of L-arginine used together with pentoxifylline is not superior to those of L-arginine or pentoxifylline alone. CONCLUSION: This study showed that L-arginine and pentoxifylline administered at the end of surgery reduced adhesion formation.

Effects of intracavernous calcium channel blockers in dogs.

Intracavernous injection of smooth muscle relaxing agents can induce penile erection. In this experimental study, we compared the effects of intracavernously injected calcium channel blockers (CCBs) and papaverine in dogs, and investigated their clinical applicabilities. We administered 30 mg papaverine, 10 mg nifedipine, 10 mg nitrendipine and 2.5 mg verapamil to 10 adult male dogs intracavernously, each at different times. Intracavernous pressure values, systemic arterial pressure values and heart rate values were recorded for 45 minutes after the intracavernous injections. We used the paired Student t-test for statistical analysis. Papaverine induced full erection in all of the 10 dogs. Nifedipine induced full erection in 4, nitrendipine in 5, and verapamil in 6 of the 10 dogs. Nifedipine and nitrendipine caused significant decreases in blood pressure and increases in heart rate. In conclusion, the effects of intracavernous CCBs are not superior to those of papaverine. We cannot recommend nifedipine and nitrendipine for intracavernous injection, but verapamil may be included in intracavernous pharmacotherapeutic combinations.