Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

Noninvasive low-intensity extracorporeal shockwave treatment (Li-ESWT) has been widely used to treat erection disorders. There is no clear information regarding either the selection of patients for the treatment or the treatment protocol. In this study, we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction (International Index of Erectile Function-5 [IIEF-5] scores of 5 to 7). Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study. The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores. The IIEF-5 score (mean ± standard deviation [s.d.]) increased from 5.29 ± 1.67 to 5.56 ± 1.85, with a difference of 0.27 ± 0.18 (P > 0.05). The Erection Hardness Scale scores (mean ± s.d.), on the other hand, increased from 1.46 ± 0.50 to 1.48 ± 0.50, with a difference of 0.02 ± 0 (P > 0.05). In conclusion, the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction (IIEF-5 scores of 5 to 7).

The Effectiveness of Jet (Needle-Free) Injector to Provide Anesthesia in Child Circumcision under Local Anesthesia.

OBJECTIVE: In our study, we aimed to evaluate the effectiveness of a needle-free (jet) injector in local anesthesia for circumcision. MATERIALS AND METHODS: A total of 64 children were divided into two groups as jet injector group (n = 32) and conventional needle group (n = 32). Ring block was applied 6-8 times with a jet injector that sprayed each time 0.1 ml (2 mg) of lidocaine in jet injector group. In conventional needle group, ring block was applied with 2 mg/kg lidocaine injection. Using FLACC (Face, Legs, Activity, Cry, Consolability) pain scale, pain score during local anesthetic injection, anesthesia start time and pain score during circumcision were determined for both groups. RESULTS: The mean age of the patients was 3.99 ± 1.41 years in jet injector group and 3.88 ± 1.33 years in conventional needle group. The mean FLACC pain score during the anesthesia procedure was 4.75 ± 0.25 in jet injector group, while it was 7.06 ± 0.24 in conventional needle group. FLACC pain scores were found to be significantly lower in jet injector group (p = 0.0001). During circumcision, the mean FLACC scores were 4.91 ± 0.29 and 2.31 ± 0.18 for jet injector group and conventional needle group, respectively. These FLACC pain scores were found to be significantly lower in conventional needle group (p = 0.0001). CONCLUSION: Our study showed that anesthesia using a jet injector can not provide sufficient analgesia so as to comfortably complete circumcision in pediatric circumcisions performed under local anesthesia.

The Effectiveness of Caudal Block with Low Doses of Dexmedetomidine and Pethidine in Transrectal Prostate Biopsy: Preliminary Results.

PURPOSE: To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. MATERIAL AND METHODS: A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. RESULTS: The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. CONCLUSION: The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.

Is it safe to use a thermocautery device for circumcision? Examination of the histopathological changes emerging after thermocautery-assisted circumcisions.

Multiple number of techniques and devices have been described concerning circumcision method so far. One of them is thermocautery device, and it has been widely used. Although there is controversy that the penis may be damaged due to the heat generated during the use of the device, not enough histopathological studies have been conducted. We aimed to determine the histopathological changes in human foreskin caused by heat after circumcision with thermocautery and to demonstrate the safety of the use of a thermocautery-assisted circumcision. Forty-one patients were divided into two groups according to the thermal energy used during cutting with thermocautery as follows: high temperature (Group 1, n = 22) and low temperature (Group 2, n = 19). The effect of the heat intensity and depth of the coagulation necrosis produced with thermocautery-assisted circumcisions performed at low and high temperatures were evaluated. The difference between the groups was not statistically significant. Tissue damage is extremely limited in thermocautery-assisted circumcisions, even when it is used at high temperatures. The thermocautery device can be used for effective and safe circumcisions.

A new perspective on penis length measurement in children: How healthy are the results obtained with the current techniques?

In order to detect abnormalities in the size of the penis, firstly, the penis length must be measured correctly. Controversies about the best technique on to be used to measure the length of the penis still persist. The hypothesis of this study is to show that penile length in children is longer than measured under normal examination conditions. A total of 155 children who applied to our institution for circumcision whose stretched penis length (SPL) measurements were performed were included in the study. The distance from the pubic bone to the tip of the glans penis, which was maximally stretched, was measured. Under normal examination conditions (SPL 1), under general anaesthesia (SPL 2) and after skin/ subcutaneous tissues were released during circumcision (SPL 3). The mean age of the patients was 4.20 ± 2.66 years. Mean SPLs were measured as 5.48 ± 1.03 and 5.96 ± 1.01 and 6.54 ± 1.01 cm in SPL 1, SPL 2 and SPL 3 respectively. The amount of increase between penis length measurements was statistically significant (p = .001). In all cases (100%), penis length measurements in SPL 3 were longer relative to SPL 1 and SPL 2.

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.

The Management of Phimosis Seen after Circumcision with Thermocautery.

OBJECTIVE: One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis. MATERIALS AND METHODS: The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks. RESULTS: A total of 32 patients with a median age of 5.1±1.1 years were included in the study out of 13285 circumcisions by thermocautery. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25±2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases. CONCLUSION: There is no place for topical steroids in management of iatrogenic phimosis after thermocautery is observed, thus, early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

Epidermoid cyst of the urinary bladder: a case report.

Epidermoid cyst of the bladder is a very rarely encountered benign lesion. Up to our knowledge, we present the second case of epidermoid cyst of the urinary bladder in literature. We report a case of epidermoid cyst developed in a 59-year-old patient followed up with bladder tumor.

Isolated congenital urethrocutaneous fistula.

Congenital urethrocutaneous fistula of the male urethra is an extremely rare anomaly that is commonly seen in association with anorectal malformations or chordee. A case of congenital urethrocutaneous fistula not associated with other congenital anomalies is reported, discussing possible etiologies and surgical management.