Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

An innovative approach to lifelong delayed ejaculation: does attachment style play a role?

PURPOSE: To examine whether there is a correlation between attachment styles, which is a developmental psychology theory, and lifelong DE. METHODS: The research was planned as prospective, multi-centric and cross-sectional study. Thirty patients who were consecutively admitted to the urology outpatient clinic and diagnosed with lifelong DE and 30 age-matched healthy controls were included in the study. All participants gave a detailed medical history and underwent a complete physical examination, and their laboratory and endocrine (prolactin and testosterone) results were evaluated. Additionally, all patients had to fill out socio-demographic information form, the Experiences in Close Relationships-Revised (ECR-R) Questionnaire, Arizona Sexual Experiences Scale (ASEX), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). RESULTS: The mean age of the DE patients was 33.5 ± 7.5 years. In the DE group, insecure attachment (both anxious and avoidant attachment), anxiety and depression scores were found to be significantly higher (p < 0.001, effect size medium or large) than the control group. Ejaculation times (both for vaginal intercourse and masturbation) were correlated with both insecure (anxious and avoidant) attachment types, as well as their anxiety and depression scores (p < 0.001). The ASEX satisfaction, ejaculation and total scores were found to be higher in DE patients (higher scores indicating greater sexual dysfunction) than in the control group. CONCLUSION: The large and significant relationships found between lifelong DE and attachment insecurities point to childhood developmental processes. The findings may help us better understand lifelong DE. There is a need for further extensive research on this subject.

Can the Irisin be a Biomarker for Prostate Cancer? A Case Control Study.

AIM: There is much evidence of an association between cancer and irisin that is an adipokine. This study researched on the relationship between prostate cancer (PCa) and irisin levels, and whether irisin can be used as a biomarker in the diagnosis of PCa. MATERIALS AND METHODS: For the study groups, 50 primary PCa patients and 30 healthy male subjects were included in the PCa and healthy control groups, respectively. All volunteers in the healthy control group were screened for prostate cancer and other malignancies and chronic diseases. Volunteers who were determine to be completely healthy were included for healthy control group. In the serum samples of the subjects were measured free PSA, total PSA and irisin levels. Irisin levels were compared separately in terms of the Gleason scores and T stage. In addition to intergroup comparisons, the ROC curve for the irisin was plotted and power analysis was performed. RESULTS: Free and total PSA levels in the PCa group were significantly higher compared to the healthy control group (p<0.05). In addition, irisin levels in the PCa group were significantly lower  than in the healthy control group (p<0.05). There was no significant difference between irisin levels in the groups classified in terms of Gleason scores (p>0.05).  When the cut-off value was taken as 8.1, the sensitivity and specificity of irisin for PCa were as 80.5% and 90%, respectively. CONCLUSION: The results of this study indicate that the levels of irisin in the PCa group are considerably reduced and irisin may be used as a biomarker as well as free and total PSA.