Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy.

BACKGROUND: Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen. Although endoscopic methods are mostly used in its treatment, it has high recurrence rates. Therefore, open urethroplasty is recommended after unsuccessful endoscopic treatments. AIM: To investigate the risk factors associated with urethral stricture recurrence. METHODS: The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed. Demographic data, comorbidities, preoperative haemogram, and biochemical values obtained from peripheral blood and operative data were recorded. Patients were divided into two groups in terms of recurrence development; recurrence and non-recurrence. Initially recorded data were compared between the two groups. RESULTS: A total of 303 patients were included in the study. The mean age of the patients was 66.6 ± 13.6 years. The mean duration of recurrence development was 9.63 ± 9.84 (min-max: 1-39) months in the recurrence group. Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15 ± 24.07 (min-max: 12-84) months. In the comparison of both groups, the presence of diabetes mellitus (DM), hypertension (HT), and multiple comorbidities were significantly higher in the recurrence (+) group (P = 0.038, P = 0.012, P = 0.013). Blood group, postoperative use of non-steroidal anti-inflammatory drugs, preoperative cystostomy, cause of stricture, iatrogenic cause of stricture, location and length of stricture, indwelling urinary cathater size and day of catheter removal did not differ between the two groups. No statistically significant difference was observed between the two groups in terms of age, uroflowmetric maximum flow rate value, hemogram parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting blood sugar, creatinine, glomerular filtration rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte-lymphocyte ratio and AST/ALT ratios. CONCLUSION: In patients with urethral stricture recurrence, only the frequency of DM and HT was high, while inflammation marker levels and stricture-related parameters were similar between the groups.

The Efficiency of Acoustic Radiation Force Impulse (ARFI) Elastography in the Differentiation of Renal Cell Carcinoma and Oncocytoma.

PURPOSE: This study is to investigate the effectiveness of Acoustic Radiation Force Impulse (ARFI) elastography in differentiating radiologically similar renal cell carcinoma (RCC) and oncocytoma in solid masses of the kidney. METHODS: The patients with solid renal mass histopathological diagnosed after excision or tru-cat biopsy who underwent a preoperative ARFI elastography of the lesion during a 4-year period were included in this study. Preoperative shear wave velocity (SWV) values were measured in all the lesions. SWV results of RCCs and oncocytomas were compared by an independent t-test, and cut-off, sensitivity and specificity values were calculated. RESULTS: Forty-two of the 60 patients included in the study were men (70%) and, 18 were women (30%), and the mean age was 59.7 ± 14 (27-94) years. Among 46 RCCs (76.6%), 23 and 14 oncocytomas, 5 (23.4%) were located in the right kidney (p:0.34722). Mean SWV values were found to be significantly higher in RCCs (2.87± 0.74 (0.96-4.14) m/s) than oncocytomas (1.83 ± 0.78 (0.80-3.76) m/s) (p <0.001). In the ROC analysis, a cutoff value of 2.29 m/s was found to havean 80.4% sensitivity and a 78.6% specificity for the discrimination of RCCs from oncocytomas. CONCLUSION: ARFI elastography measurements may be useful in distinguishing RCC and oncocytomas that may have similar solid radiological imaging features.

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.

The Impact of Ureteral Wall Thickness on Spontaneous Passage and Development of Long-term Ureteral Stricture in Patients with Ureteral Stone.

OBJECTIVE: To evaluate the association of ureteral wall thickness (UWT) with spontaneous passage (SP) of ureteral stones and formation of ureteral stricture (US) in patients who underwent ureterorenoscopy for ureteral stones. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Turkey, between January 2019 and June 2021. METHODOLOGY: One hundred and sixty-nine patients with ureteral stones were restrospetively reviewed for maximum stone diameter, stone density, degree of hydronephrosis, parenchymal thickness, and UWT measurement from CT images. The patients were divided into two groups; patients who had (group 1) and had not (group 2) undergone SP of ureteral stones. These two groups were compared for stone characteristics and UWT. Ureterorenoscopy was performed on 52 patients who did not experience SP. Data related to the passage of guide wire and radio-opaque material, drainage method, ureteral wall injury and patients who developed US were recorded. Ureterorenoscopy group were divided into two groups of patients who did and did not develop stricture. These two groups were compared for stone characteristics and perioperative findings. RESULTS: Of the 169 patients, 106 (62,7%) patients spontaneously passed stones. Ureterorenoscopy was performed on 52 patients. US developed in 9 (17%) patients. Maximum stone diameter, density, and antero-posterior (AP) diameter of the renal pelvis and UWT were statistically different between both groups. The degree of hydronephrosis, ureteral wall injury, density, AP diameter of the stones, parenchyma thickness, length of hospital stay, and UWT were found to be significantly increased in the stricture group. CONCLUSION: UWT is a simple measurement that can be used to predict SP of ureteral stones. It can also predict the development of US after ureterorenoscopy in long-term. KEY WORDS: Ureteral calculi, Ureterorenoscopy, Ureteral wall thickness, Ureteral stricture.

Has the COVID-19 Pandemic Affected Community-Acquired Urinary Tract Infections in Children?

PURPOSE: To evaluate whether there were any changes in the rates of urinary tract infection (UTI) and antibiotic resistance in pediatric patients during the pandemic period. MATERIALS AND METHODS: Urine culture samples collected due to suspected UTI were searched retrospectively from our hospital database, and the patients with growth in urine culture were identified. They were divided into 2 groups as Group A (before COVID-19, March 11, 2019- March 11, 2020) and Group B (COVID-19 period, March 11, 2020- March 11, 2021). Also, COVID-19 period was divided into 3 subgroups (March 2020- June 2020: first epidemic peak, July 2020 - November 2020: normalization process, December 2020- March 2021: second epidemic peak). We adjusted the patient age as <1, 1-6 and 7-18 years. Age, gender, microorganism strain types, and their antibiotic resistance patterns were compared between the 2 groups Results: This cross-sectional study included 250 eligible patients (Group A, n=182 and Group B, n=68) with a mean age of 10.91 ± 5.58 years. The male/female ratio was higher in Group B than in Group A (p = .004). Incidence of UTIs was lower in the curfew and restriction periods due to epidemic peaks than normalization process (p = .001). The proportion of E.coli decreased from 80.2% to 61.8% during the pandemic period when compared to pre-pandemic period (p = .001). Group B had lower rates of resistance to ampicillin, fosfomycin and nitrofurantoin for E.coli than Group A (p = .001, p = .012 and p = .001, respectively). Also, Group B had higher rate of uncommon microorganisms and lower rate of resistance to nitrofurantoin for E.coli than Group A in patients aged 7-18 years (p = .003 and p = .023, respectively). CONCLUSION: Our study demonstrates that the ongoing COVID-19 pandemic process has caused alterations in community-acquired UTIs in children. More hygienic lifestyle may be considered as the main factor in this change.

Do SARS-CoV-2 Infection (COVID-19) and the Medications Administered for Its Treatment Impair Testicular Functions?

PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted primarily via respiratory droplets and enters host cells through angiotensin-converting enzyme 2 (ACE-2) receptors. ACE-2 receptors have been identified in many tissues including testes. The aim of the study has been to investigate the long-term effects of SARS-CoV-2 infection (COVID-19) and its relative treatment on male reproductive health. METHODS: Cross-sectional analysis has been performed on 49 recovered COVID-19 patients who had semen analysis prior to the COVID-19 pandemic. Those who had a recovery time lag of at least 3 months have been re-examined, and 29 eligible patients with no andrological problems have been enrolled in the study. Following a detailed physical examination and retrieval of medical history, the values of semen analysis and serum sex hormone parameters have been collected and compared before and after COVID-19 infection. The p value of <0.05 has been considered significant. RESULTS: The average age of the 29 patients has been 31.21 ± 5.48 (range: 18-41) years. Favipiravir has been co-administered with hydroxychloroquine in 17 patients, while the remaining 12 received favipiravir treatment without hydroxychloroquine. The average time between clinical recovery from COVID-19 and collection of semen has been 4.52 ± 1.36 (range: 3-8) months. Before and after COVID-19, serum follicle-stimulating hormone, luteinizing hormone, total testosterone, and prolactin levels, as well as all semen parameters, have been comparable. CONCLUSION: Our study demonstrated that COVID-19 and its treatment with favipiravir and hydroxychloroquine did not affect spermatogenesis and serum androgen levels in the long-term period. Further clinical studies with larger sample size are needed to confirm and support our findings.

Influence of COVID-19 pandemic on sexuality: a cross-sectional study among couples in Turkey.

Coronavirus disease 2019 (COVID-19) pandemic has been continuing to affect the lives of all people globally. It has been shown that restrictions due to changes in lifestyles lead to mental health problems. This study aims to investigate the effect of COVID-19 pandemic on couples' sexuality. A total of 245 volunteers (148 men and 97 women) were enrolled in the study. Generalized Anxiety Disorder-7, Patient Health Questionnaire, Perceived Stress Scale were administered to screen anxiety and depression symptoms. International Index of Erectile Function (IIEF-15) and Female Sexual Function Index (FSFI) along with self-constructed sexual behavior questionnaire were administered to participants, in order to evaluate sexual functions and behavioral changes during the pandemic. Sexual function scores (IIEF erectile function domain and total FSFI) during pandemic (24.55 ± 5.79 and 24.87 ± 7.88, respectively) were lower compared to the prepandemic period (26.59 ± 4.51 and 26.02 ± 6.22, respectively) (p = 0.001 and p = 0.027, respectively). During pandemic compared to prepandemic period, the frequency of sexual intercourse decreased in men (p = 0.001) and women (p = 0.001) while sexual avoidance and solitary sexual approach behaviors (masturbation or watching sexual content videos, etc.) increased in men (p = 0.001) and women (p = 0.022). However, the couples that spent more time together during the pandemic reported better sexual function scores (men; p = 0.001, women; p = 0.006). Although this is the first study evaluating couples from Turkey with a convenience sample, further studies with a greater number may better elucidate the effects of this pandemic on sexuality.

Can continuous positive airway pressure improve lower urinary tract symptoms and erectile dysfunction in male patients with severe obstructive sleep apnea syndrome?

PURPOSE: We aimed to investigate the effect of continuous positive airway pressure (CPAP) administered for the treatment of obstructive upper airway on lower urinary tract symptoms and erectile dysfunction in male patients. MATERIALS AND METHODS: A total of 626 male with suspected obstructive sleep apnea syndrome (OSAS) were evaluated prospectively. Nocturnal polysomnography tests were administered to the male. After application of the exclusion criteria, 54 patients with severe OSAS (Apnea-Hypopnea Index ≥30) were included in the study. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15), and nocturia were assessed in all patients before and after CPAP therapy, and prostate volume, total prostate-specific antigen (tPSA), and uroflowmetric measurements were assessed in patients aged >40 years. RESULTS: The mean age of the 54 patients was 47.06±11.15 years. Post-treatment IIEF scores were better than pre-treatment scores (24.27±7.58 vs. 22.68±8.65, p=0.014). IPSS values, nocturia, and uroflowmetric outcomes significantly improved after CPAP therapy (p<0.05). On the other hand, mean values of body mass index, tPSA, prostate volume, and postvoid residual urine volume did not differ significantly after treatment. CONCLUSIONS: CPAP therapy improves lower urinary tract symptoms, nocturia, and erectile dysfunction in male with severe OSAS.

Microorganisms and antibiotic susceptibilities isolated from urine cultures.

OBJECTIVES: Urinary tract infection (UTI) is the second most common cause of infection among all infectious diseases at hospitals. Antibiogram results are needed to maintain treatment in patients with suspected UTI. However, empirical antibiotic treatment is initiated in patients since it takes time to obtain the results of antibiograms. The aim of this study was to evaluate the urine culture and antibiogram results of patients who were admitted to our hospital with suspected UTI and compare the results with other studies. METHODS: Urine cultures requested from the hospital information system database between January of 2018 and 2019 were analyzed. Microorganism-positive urine samples and antibiogram results were evaluated and included in the study. RESULTS: Of the patients, 748 (61.8%) were female and 463 (38.2%) were male. The average age of all patients was 44.9 years. Escherichia coli was the most frequently isolated microorganisms from urine cultures (n = 828, 68.4%). Among all microorganism-positive urine samples, antibiotic resistance against Cefalexin, Fusidic acid, Ampicillin, Erythromycin, Levofloxacin, Cefuroxime Axetil, Trimethoprim/ Sulfamethoxazole, Ceftriaxone and Ciprofloxacin was 83.9%, 68.4%, 61.8%, 44.7%, 42.7%, 36.4%, 30%, 28.6% and 26.7%, respectively. CONCLUSIONS: High resistance to Cefalexin, Ampicillin, Cefuroxime, Axetil, Trimethoprim/ Sulfamethoxazole, Ceftriaxone and Ciprofloxacin, which are often preferred in empirical antibiotic selection, has been found. We believe that empirical antibiotic selection should not be overlooked in cases of UTI. Our study may help clinicians use appropriate antibiotics for the clinical management of UTIs.

Impact of dutasteride on spermatogenesis and oxidative status in rats. / Impacto de dutasteride en la espematogénesis y el estrés oxidativo en ratas.

OBJECTIVES: Although the association between 5 alpha reductase inhibitors used for the treatment of both androgenetic alopecia and benign prostatichy perplasia and their side effects is well established, the impact of dutasteride on testicular structure is not clear. To evaluate the alterations in spermatogenesis and serum FSH, LH, testosterone and dihydrotestosterone concentrations along with the oxidative status in testes and blood of the rats treated with daily dutasteride. METHODS: A total of 18 male Sprague-Dawley rats have been divided into 2 groups as control (n=8) and dutasteride (n=10). After chronically administered, rats were sacrificed and their testes were harvested for histopathologica land biochemical evaluation.  Johnsen's criteria were used to assess spermatogenesis. Serum hormone concentrations and levels of reactive oxygenspecies (ROS) in both testicular tissue and serum were measured by ECLIA and ELISA, respectively. Results were compared with Mann- Whitney U test. RESULTS: DHT (7.35 ± 0.35 vs. 10.54 ± 0.95,p<0.001) and LH levels (0.32 ±  0.009vs. 0.43 ±  0.01,<0.001) were significantly lower in treatment group compared with controls where as testosterone levels were higher in dutasteride arm (3.41 ± 1.12 vs.1.52 ± 0.34, p<0.001). Johnsen score, serum FSH levels, serum and tissue ROS levels were similar betweenthe two groups. CONCLUSIONS: According to our results, administration of dutasteride does not appear to modify spermatogenesis and oxidative burden in rats. Further investigations are required to confirm our findings.

OBJETIVOS: Aunque la asociación entre los inhibidores de la 5'alfa reductasa y el tratamiento de la alopecia y de la hiperplasia benigna de próstata esta bien establecido, el impacto de dutasteride en la estructura testicular no esta claro. El objetivo de este trabajo es evaluar las alteraciones en la espermatogénesis y concentraciones de FSH, LH, testosterona y dihidrotestosterona junto con el estado oxidativo del testículo y en sangre de ratas con la administración diaria dedutasteride. MÉTODOS: Un total de 18 ratas Sprague Dawle fueron divididas en 2 grupos: control (n=8) y dutasteride (n=10). Después de una administración crónica de dutasteride, las ratas fueron sacrificadas y los testículos se analizaron del punto de vista anatomopatológico y bioquímico. Los criterios de Johnsen fueron utilizados para valorar la espermatogénesis. Los niveles séricos hormonales y de especias reactivas del oxigeno en el tejido testicular y serum fueron medidos con ECLIA y ELISA respectivamente. Los resultados se compararon con Test Mann-Whitney. RESULTADOS: Los niveles de DHT (7,35 ± 0,35 vs.10,54 ± 0,95, p<0,001) y LH ( ,32± 0,009 vs. 0,43 ± 0,01, <0,001) fueron significativamente menores en el grupo tratamiento en comparación con los controles, mientras que los niveles de testosterona fueron mas elevados en el brazo de dutasteride (3,41 ± 1,12 vs. 1,52 ± 0,34, p<0,001). El score de Johansen los niveles séricos de FSH y de ROS fueron similares entre ambos grupos. CONCLUSIONES: De acuerdo con nuestros resultados, la administración de dutasterida no parece modificar la espermatogénesis y la carga oxidativa en ratas. Mas investigaciones son necesarias para confirmar nuestros hallazgos.

Impact of dutasteride on spermatogenesis and oxidative status in rats / Impacto de dutasteride en la espematogénesis y el estrés oxidativo en ratas

OBJECTIVES: Although the association between 5 alpha reductase inhibitors used for the treatment of both androgenetic alopecia and benign prostatic hyperplasia and their side effects is well established, the impact of dutasteride on testicular structure is not clear. To evaluate the alterations in spermatogenesis and serum FSH, LH, testosterone and dihydrotestosterone concentrations along with the oxidative status in testes and blood of the rats treated with daily dutasteride. METHODS: A total of 18 male Sprague-Dawley rats have been divided into 2 groups as control (n=8) and dutasteride (n=10). After chronically administered, rats were sacrificed and their testes were harvested for histopathological and biochemical evaluation. Johnsen's criteria were used to assess spermatogenesis. Serum hormone concentrations and levels of reactive oxygen species (ROS) in both testicular tissue and serum were measured by ECLIA and ELISA, respectively. Results were compared with Mann- Whitney U test. RESULTS: DHT (7.35 ± 0.35 vs. 10.54 ± 0.95, p < 0.001) and LH levels (0.32 ± 0.009 vs. 0.43 ± 0.01, <0.001) were significantly lower in treatment group compared with controls whereas testosterone levels were higher in dutasteride arm (3.41 ± 1.12 vs. 1.52 ± 0.34, p < 0.001). Johnsen score, serum FSH levels, serum and tissue ROS levels were similar between the two groups. CONCLUSIONS: According to our results, administration of dutasteride does not appear to modify spermatogenesis and oxidative burden in rats. Further investigations are required to confirm our findings

OBJETIVOS: Aunque la asociación entre los inhibidores de la 5'alfa reductasa y el tratamiento de la alopecia y de la hiperplasia benigna de próstata esta bien establecido, el impacto de dutasteride en la estructura testicular no esta claro. El objetivo de este trabajo es evaluar las alteraciones en la espermatogénesis y concentraciones de FSH, LH, testosterona y dihidrotestosterona junto con el estado oxidativo del testículo y en sangre de ratas con la administración diaria dedutasteride. MÉTODOS: Un total de 18 ratas Sprague Dawle fueron divididas en 2 grupos: control (n = 8) y dutasteride (n = 10). Después de una administración crónica de dutasteride, las ratas fueron sacrificadas y los testículos se analizaron del punto de vista anatomopatológico y bioquímico. Los criterios de Johnsen fueron utilizados para valorar la espermatogénesis. Los niveles séricos hormonales y de especias reactivas del oxigeno en el tejido testicular y serum fueron medidos con ECLIA y ELISA respectivamente. Los resultados se compararon con Test Mann-Whitney. RESULTADOS: Los niveles de DHT (7,35 ± 0,35 vs. 10,54 ± 0,95, p < 0,001) y LH (0,32 ± 0,009 vs. 0,43 ± 0,01, < 0,001) fueron significativamente menores en el grupo tratamiento en comparación con los controles, mientras que los niveles de testosterona fueron mas elevados en el brazo de dutasteride (3,41 ± 1,12 vs. 1,52 ± 0,34, p < 0,001). El score de Johansen los niveles séricos de FSH y de ROS fueron similares entre ambos grupos. CONCLUSIONES: De acuerdo con nuestros resultados, la administración de dutasterida no parece modificar la espermatogénesis y la carga oxidativa en ratas. Mas investigaciones son necesarias para confirmar nuestros hallazgos

Effect of tadalafil on penile nitric oxide synthase and corporal smooth muscle in rats under dutasteride treatment.

Aim: To investigate the effect of tadalafil in rats administered with daily dutasteride.Methods: Twenty-four Sprague-Dawley male rats were allocated to three groups as control (group C), dutasteride (group D) and dutasteride plus tadalafil (group D + T). After a month of treatment, serum samples were obtained from rats to measure dihydrotestosterone and total testosterone. Nitric oxide (NO) synthase (NOS) immunoreactivity and levels of NOS enzyme isoforms, NO and cyclic guanosine monophosphate (cGMP) were evaluated in the harvested penile tissues. Also, corporal smooth muscle and collagen were examined.Results: Staining intensities of neuronal NOS and endothelial NOS were significantly lower in group D (p < .05). They were similar between group C and group D + T. Immunoreactivity of inducible NOS was observed higher in group D than group C (p = .01) whereas group D + T had the highest iNOS (p<.001). ELISA revealed similar outcomes in terms of NOS enzyme isoform levels. The mean of smooth muscle to collagen ratio was the lowest in group D (p < .001) and it was similar among group C and group D + T (p = .072). Group D had the lowest cGMP and NO levels (p < .05) and they did not differ between group C and group D + T (p>.05). Group D and group D + T had significantly decreased dihydrotestosterone and increased testosterone, compared to group C (p < .001). They were similar between group D and group D + T.Conclusion: Daily treatment with tadalafil improves dutasteride-induced changes in rat penis.

Frequency of nocturnal emissions and masturbation habits among virgin male religious teenagers / Frecuencia de emisiones nocturnas y hábitos de masturbación entre adolescentes varones vírgenes y religiosos

INTRODUCTION AND OBJECTIVES: Although nocturnal emission (NE) is an integral part of normal sexual function of males, little information has been documented in the literature. We aimed to assess masturbation habits and frequency of NE among virgin male religious Muslim teenagers. MATERIALS AND METHODS: A questionnaire was administered to students staying in a religious dormitory or attending a religion course. Data of 113 male-respondents including demographic characteristics, masturbation habits and frequency of NE were collected. RESULTS: The mean age of students was 15.88+/-1.47 (range: 13-20) years. Of the students, 46(41.4%) reported that they never masturbated and 19 (17.3%) never experienced NEs. NE frequency was not correlated with age (p = 0.092). Having NEs was not related to the time since last masturbation either (p = 0.479). Subjects watching TV more than 3h/day had more NEs than the ones watching less (p = 0.006). Of the subjects 13.6%, 12.6% and 67% believed that masturbation is halal, permissible and forbidden by religion, respectively whereas these rates were 59.1%, 20.4% and 7.5% for NE. CONCLUSIONS: Although masturbation and NE are frequent among virgin male religious Muslim teenagers, a significant proportion of young men believe that only masturbation, but not NE, is forbidden by religion. Watching TV seems to be associated with the frequency of NEs. Further studies are required to elicit the factors affecting frequency of NEs

INTRODUCCIÓN Y OBJETIVOS: Aunque la emisión nocturna (EN) es una parte integral de la función sexual normal de los varones, hay poca información documentada en la bibliografía. Nuestro objetivo es evaluar los hábitos de masturbación y la frecuencia de las EN entre los adolescentes musulmanes vírgenes y religiosos. MATERIALES Y MÉTODOS: Se facilitó un cuestionario a estudiantes de una residencia religiosa o que asistían a un curso de religión. Se recogieron datos de 113 varones encuestados, incluidas las características demográficas, los hábitos de masturbación y la frecuencia de EN. RESULTADOS: La media de edad de los estudiantes fue de 15,88+/-1,47 (rango: 13-20) años. Cuarenta y seis estudiantes (41,4%) afirmaron que nunca se habían masturbado y 19 (17,3%) nunca habían experimentado una EN. La frecuencia de EN no se correlacionó con la edad (p = 0,092). Tener EN tampoco estaba relacionado con el tiempo transcurrido desde la última masturbación (p = 0,479). Los individuos que veían la televisión más de 3h al día presentaban mayor tasa de EN, que los que la veían menos de 3h (p = 0,006). De los individuos encuestados, el 13,6, el 12,6 y el 67% creían que la masturbación es halal, aceptable y prohibida por la religión, respectivamente, mientras que estas tasas fueron del 59,1, del 20,4 y del 7,5% para la EN. CONCLUSIONES: Aunque la masturbación y las EN son frecuentes entre los adolescentes musulmanes vírgenes y religiosos, una proporción considerables de ellos cree que la religión prohíbe la masturbación, pero no la EN. Parece que ver la televisión está asociado con la frecuencia de las EN. Se requieren más estudios para obtener los factores que afectan a la frecuencia de las EN

Comparative efficacy and safety profile of 4 vs 8 mg of silodosin once daily usage in patients with benign prostatic hyperplasia-related lower urinary tract symptoms divided into subgroups according to International Prostate Symptom Score severity.

BACKGROUND: The purpose of this study was to compare once daily (QD) usage of 4 and 8 mg of silodosin in patients divided as those with moderate and with severe lower urinary tract symptoms (LUTSs) according to International Prostate Symptom Score (IPSS) categories in terms of effectiveness and adverse events. METHODS: A total of 234 patients aged ≥ 40 years were evaluated prospectively. All participants were divided firstly into two groups according to their IPSS severity as moderate and severe. They were further allocated to receive 4 mg of silodosin and 8 mg of silodosin QD. Demographic features and laboratory tests were recorded. The patients were questioned with International Index of Erectile Function-5 and IPSS along with quality of life index. Uroflowmetric measurements were applied to the patients. All tests and measurements were repeated at the 3rd month, and changes from pretreatment to posttreatment were analyzed by SPSS 21.0 Program. The statistical significance level was set at p < 0.05. RESULTS: Both treatments provided benefit in patients with both moderate and severe LUTSs. While results did not differ among 4 mg and 8 mg of silodosin in patients with moderate LUTSs, 8 mg of silodosin was significantly better than 4mg in those with severe LUTSs in terms of improvement of the total IPSS, IPSS voiding subtotal score, and quality of life score (p = 0.015, 0.030, <0.001, respectively). Both treatments did not affect erectile functions. Adverse events were seen more frequently in patients receiving 8 mg of silodosin than those treated with 4 mg of silodosin (p = 0.024). CONCLUSION: Our study revealed that 4 mg of silodosin QD was as effective as 8 mg of silodosin QD in patients with moderate LUTSs but not with severe LUTSs. It can be inferred from this study that prescription of 4 and 8 mg of silodosin may be chosen to treat the patients with moderate and severe LUTSs due to benign prostatic heperplasia, respectively.

Frequency of nocturnal emissions and masturbation habits among virgin male religious teenagers.

INTRODUCTION AND OBJECTIVES: Although nocturnal emission (NE) is an integral part of normal sexual function of males, little information has been documented in the literature. We aimed to assess masturbation habits and frequency of NE among virgin male religious Muslim teenagers. MATERIALS AND METHODS: A questionnaire was administered to students staying in a religious dormitory or attending a religion course. Data of 113 male-respondents including demographic characteristics, masturbation habits and frequency of NE were collected. RESULTS: The mean age of students was 15.88±1.47 (range: 13-20) years. Of the students, 46(41.4%) reported that they never masturbated and 19 (17.3%) never experienced NEs. NE frequency was not correlated with age (p=0.092). Having NEs was not related to the time since last masturbation either (p=0.479). Subjects watching TV more than 3h/day had more NEs than the ones watching less (p=0.006). Of the subjects 13.6%, 12.6% and 67% believed that masturbation is halal, permissible and forbidden by religion, respectively whereas these rates were 59.1%, 20.4% and 7.5% for NE. CONCLUSIONS: Although masturbation and NE are frequent among virgin male religious Muslim teenagers, a significant proportion of young men believe that only masturbation, but not NE, is forbidden by religion. Watching TV seems to be associated with the frequency of NEs. Further studies are required to elicit the factors affecting frequency of NEs.

Intracutaneous sterile water injection for pain relief during extracorporeal shock wave lithotripsy: comparison with diclofenac sodium.

Various analgesic applications can be used during extracorporeal shock wave lithotripsy (SWL) for pain relief and maximal success rate. Intracutaneous sterile water injection (ISWI) has been shown to be effective in several types of pain, but a gap exists about its use during SWL. In this paper, we aimed to evaluate the effect of ISWI during SWL and compare that with diclofenac sodium injection used commonly to provide ideal patient contentment. Patients with kidney stone were randomized to have either ISWI therapy or intramuscular non-steroid anti-inflammatory drug (diclofenac sodium) injection. Using a syringe, 2-3 ml of sterile water was administered to the triangle area bounded by the 12th costal margin, the iliac crest and the vertebral spine in prone position. Visual analog scale (VAS) was employed to record pain scores of patients. Other parameters including stone size, SWL duration, total shock waves given, used energy and the necessity of rescue analgesia were also noted. A total of 524 patients were recruited, of those 216 patients were treated with ISWI and 308 patients had diclofenac sodium injections. The characteristics of the patients and shockwave therapy did not differ significantly between the two groups. Although the mean VAS scores prior to SWL and at every voltage increment during the procedure did not differ, more patients in the diclofenac sodium injection group required rescue analgesia with significantly greater side effects. ISWI is found to be as effective as the diclofenac sodium injection for pain management during SWL with lower adverse event rates.

Gas (Oxygen) insufflation: A new technique for the visualization of the operative field during hypospadias surgery.

OBJECTIVE: Maintaining a bloodless operative field is a crucial step in achieving success and reducing complications in hypospadias surgery. So, far, the most harmless and least damaging technique in terms of penile tissue oxygenation during hemostasis has not still been defined. We aimed to present our new technique of gas (oxygen) insufflation for better visualization of the operative field, and to compare this with the control group, where a wet sponge was used for hemostasis. MATERIAL AND METHODS: A total of 28 patients with primary distal hypospadias who were treated with modified tubularized incised plate urethroplasty (TIPU) repair between March 2017 and October 2018 were evaluated prospectively. The patients were divided randomly into two groups. While only a wet sponge was used to clean hemorrhagic area in the control group (group I) (n=12), gas (oxygen) insufflation was used to visualize the operative field during the operation in the patient group (group II) (n=16). The patients' ages, operation time, follow-up durations, and postoperative complications were documented and statistically compared. RESULTS: The mean ages and follow-up durations of both groups were found to be similar. The operation time was statistically shorter in group II than in group I (p=0.01). Eight patients (66.7%) in group I showed a complication, while 2 patients (12.5%) in group II showed a complication (p=0.005). CONCLUSION: The gas (oxygen) insufflation technique provides good visualization during the dissection step of hypospadias surgery and results in better postoperative outcomes. Therefore, we think that this technique can be preferred as an alternative method for the visualization of the operative field in hypospadias surgery.

Tadalafil Preserves Penile Nitric Oxide Synthase from Detrimental Effect of Paroxetine in Rats.

OBJECTIVE: Paroxetine is a commonly prescribed SSRI that can impair erectile function in animal models via inhibition of nitric oxide synthase (NOS). Tadalafil potentiates nitric oxide (NO)-mediated responses in isolated trabecular smooth muscle and penile erection. The purpose of this study was to evaluate the impact of co-administering tadalafil with paroxetine on penile NOS levels in rats. MATERIALS AND METHODS: A total of 30 male Sprague-Dawley rats were divided into 3 groups as control (Group-C), paroxetine (Group-P) and paroxetine plus tadalafil (Group-P+T). After 28 days of treatment, rats were sacrificed and their penile tissues were harvested for analysis. NOS isoform protein levels and immunoreactivity scores of NOS were assessed. Statistical significance level was set at p<0.05. RESULTS: Neuronal NOS (nNOS) levels were significantly decreased in group-P, compared with group-C (p<0.001). In comparison, rats in group-P+T had significantly higher nNOS levels compared to group-P (p<0.001). Endothelial NOS (eNOS) and inducible NOS (iNOS) levels were significantly higher in group-P compared with group-C (p<0.01). The levels of eNOS and iNOS in group-P+T were similar to group-C. CONCLUSION: Daily treatment with tadalafil prevented chronic paroxetine-induced changes in all three NOS isoform levels. Tadalafil treatment may therefore be a useful therapy in men with paroxetine-associated erectile dysfunction.