The relationship between the second-to-fourth digit ratios and lifelong premature ejaculation: a prospective, comparative study.

To investigate the relationship between the fetal androgen exposure and lifelong premature ejaculation by using the ratio of the second (index)-to-fourth (ring) digits (2D : 4D) which is the marker for higher prenatal androgen exposure. Totally 65 patients with lifelong premature ejaculation and 65 control cases without any ejaculatory complaints were enrolled in the study. A detailed medical history was obtained and self-estimated intravaginal ejaculatory latency times were recorded. Ejaculation function was evaluated by Premature Ejaculation Diagnostic Tool. The lengths of the second and fourth digits of both hands were measured and 2D : 4Ds were calculated. The mean 2D : 4D values were 0.964 ± 0.024 vs. 0.978 ± 0.032 (p = 0.004) for the right hand and 0.966 ± 0.023 vs. 0.979 ± 0.032 (p = 0.006) for the left hand in lifelong premature ejaculation and control groups, respectively. Significant correlations were observed between the digit ratios and self-estimated intravaginal ejaculatory latency time (r = 0.258, p = 0.003 for right hand; r = 0.240, p = 0.06 for left hand), and between the digit ratios and total Premature Ejaculation Diagnostic Tool scores (r = -0.263, p = 0.003 for right hand; r = -0.238, p = 0.06 for left hand). Individuals with lower digit ratios have higher risks of shorter intravaginal ejaculatory latency times. These results suggest that increased fetal androgen exposure may be a new risk factor for the development of lifelong premature ejaculation.

The effect of verapamil on the prevention of ischemia/reperfusion injury in the experimental retroperitoneoscopic donor nephrectomy model.

BACKGROUND: This study investigated the effect of intravenous administration of verapamil in prevention of the injury caused by free oxygen radicals generated in a rabbit retroperitoneoscopic donor nephrectomy model. METHODS: Twenty-four adult New Zealand rabbits were divided into four groups. In group I, balloon dissection of the left retroperitoneal space was performed. In group II, CO2 at 10 mmHg was applied for 3 hours after the balloon dissection. In group III, laparotomy was performed, the left renal pedicle was clamped for 3 min, and the clamp was removed 5 min before nephrectomy. In group IV, 2 min before the attempt 0.2 mg/kg verapamil was given intravenously, and the same procedure was employed as in group III. Nephrectomy was performed after each experiment. The concentrations of malonyl dialdehyde (MDA), reduced glutathione (GSH), and protein carbonyl content were measured in renal tissue samples as markers of oxidative stress. RESULTS: Pneumoretroperitoneum (Prp) promoted oxidative stress in renal tissues, with an increase of MDA and protein carbonyl content. The verapamil- pretreated group (group IV) showed statistical significantly lower values of MDA and protein carbonyl content when compared with group II and III (p < 0.05), whereas tissue GSH concentrations were unchanged in all groups. CONCLUSIONS: Our study showed that Prp causes increased oxidative stress in renal tissue. Warm ischemia lasting 3 min did not exert an additive effect on Prp-associated oxidative stress. Verapamil reduces the oxidative stress markers caused by Prp.

Early tissue reactions in the rat bladder wall after contact with three different synthetic mesh materials.

OBJECTIVES: To investigate bladder tissue reactions to three types of implanted mesh material, i.e. polypropylene, polyglactin and polypropylene-polyglactin combined. MATERIALS AND METHODS: Forty-eight adult female Wistar albino rats were randomized to four equal groups, i.e. group 1 (sham-operated controls), group 2 (polypropylene mesh), group 3 (polyglactin mesh) and group 4 (polypropylene-polyglactin mesh). A laparotomy incision was made to access the bladder and fix a 0.5 x 1 cm piece of mesh directly on the bladder wall. Each group was randomly divided into two subgroups of six animals, killed at 7 and 14 days after mesh implantation, respectively, to study mesh and tissue features with time. Bladders were harvested for histological and immunohistochemical investigation. Microvessels that developed around the mesh were detected with the avidin-biotin peroxidase system, using antibody to Factor VIII-related antigen as an endothelial marker. Vessels were counted in the most intensely stained area of one section from each animal's bladder. RESULTS: Compared with the other groups, group 4 had more inflammatory reaction at 7 days but the tissue reactions to all mesh materials were similar at 14 days; the mesh penetrated the bladder muscularis propria at 14 days in all six rats in group 2, in one in group 3, and two in group 4. Group 4 tended to have a greater microvessel density at 14 than at 7 days. In contrast, groups 2 and 3 had lower microvessel densities at 14 than at 7 days. CONCLUSION: The rat bladder wall had a similar early response to all three types of mesh materials. Penetration was more marked with polypropylene mesh than with the other materials. This nonabsorbable material persists in tissue and is currently widely used for clinical applications. These results for penetration suggest that the use of polypropylene mesh risks serious postoperative complications, e.g. urethral tissue erosion.

Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele.

OBJECTIVE: The standardization of diagnostic criteria for varicocele has not yet been established. This causes difficulty in evaluating both the incidence and clinical studies. Our aim was to establish diagnostic criteria for varicocele in Doppler procedures. METHODS: The characteristics of blood flow in the internal spermatic vein were investigated with color Doppler ultrasonography (CDU) and venous flow spectral analysis in 100 infertile men without clinical varicocele (group I), 100 infertile men with clinical left varicocele (group II), and 50 fertile men without clinical varicocele served as controls (group III). RESULTS: Three types of flow pattern were found in the spectral analysis of venous flow. If the venous flow was directed to the heart and did not change direction with an intra-abdominal pressure increase, it was classified as type I; venous flow directed to the heart, but changing direction with an intra-abdominal pressure increase, was classified as type II, and blood flow directed to the testicles and augmenting with an intra-abdominal pressure increase, was classified as type III. In group I, flow patterns were 39, 56 and 5% on the left side and 55, 42 and 3% on the right side for types I, II and III, respectively. In group II, flow patterns were 0, 35 and 65% on the left side and 61, 38 and 1% on the right side for type I, II and III patterns, respectively. In group III, the figures were 44, 54 and 2% for the left and 54, 46 and 0% for the right. Type II and III flow patterns were seen more frequently than type I in patients with clinical left varicocele (p<0.001). Whereas type I and II flow patterns were more common than type III in subjects without clinical varicocele (p<0.05). A type II flow pattern during normal breathing was seen at a lower rate in the control group than in the other groups (p<0.05). CONCLUSION: Spectral analysis of Doppler waves should be used in combination with CDU for the diagnosis of varicocele. Varicocele should not only be diagnosed with a type II flow pattern which occurs during valsalva. For the diagnosis of varicocele, the main criterion must be a type III pattern flow, as well as a type II pattern during normal breathing.

Histopathological and functional effects of radiation therapy in obstructive uropathy.

Leukocyte influx into the cortex and medulla of the kidney is seen following acute ureteral obstruction. To investigate the macrophage influx and alterations in glomerular filtration rate (GFR) and to evaluate the effects of early radiation therapy on these parameters, we evaluated 20 rabbits in four groups. In the first group preoperative technetium-99m scanning preceding bilateral ureteral complete obstruction was performed. All rabbits received whole body irradiation of 1316 rads. Then the bilateral ureteral obstruction was released after 24 hours. Two hours after releasing, the last scanning was performed. The kidneys were immediately removed and histopathological examination was done. In the second group, all procedures except radiotherapy were done. The third group underwent sham laparotomy to assess the effects of surgical trauma on renal functions. The fourth group of rabbits was considered as control. We have observed an apparent macrophage influx into the cortex and medulla of the kidney following bilateral ureteral obstruction (p=0.000). However, irradiation reduced the infiltration significantly (p=0.000). Also in cases who received radiotherapy GFR was preserved to a significantly higher degree (p=0.000). We concluded that irradiation following acute ureteral obstruction has protective effects on renal function through abolition of the infiltrating cells.

Effectiveness of oxybutynin hydrochloride in the treatment of enuresis nocturna--a clinical and urodynamic study.

OBJECTIVE: To find the efficacy and optimal dosage of oxybutynin HC1 in a group of enuretic children, who were non-responsive to imipramine. MATERIAL AND METHODS: Thirty-six patients with enuresis who were non-responsive to imipramine were urodynamically assessed and subsequently treated with oxybutynin hydrochloride (HCl). Patients with inadequate bladder storage function (IBSF) were started on 10-mg daily oxybutynin HCl for one month. If the initial treatment was found to be inadequate, the dose was increased to 15 mg daily. The dose in patients who were non-responsive to 15-mg daily dose was increased to 20-mg daily dose. Patients who were normal urodynamically were treated with a dose of 15 mg daily for one month. RESULTS: Before the treatment, 17 patients had IBSF (47.2%). The majority of the patients (88.2%) with IBSF were responsive to the 15-mg daily oxybutynin HCl. The treatment in patients with normal bladder function was generally unsuccessful. CONCLUSIONS: Oxybutynin HCl in sufficient dosages seems to be effective in the treatment of enuretic patients with IBSF.

Prospective evaluation of prostate specific antigen (PSA), PSA density, free-to-total PSA ratio and a new formula (prostate malignancy index) for detecting prostate cancer and preventing negative biopsies in patients with normal rectal examinations and intermediate PSA levels.

OBJECTIVE: To improve the specificity and sensitivity of prostatic cancer detection, we prospectively evaluated total prostate specific antigen (PSA) level, PSA density, free-to-total PSA ratio and a new formula called prostate malignancy index (PMI) as a discriminator of prostate cancer in patients with intermediate PSA levels and normal digital rectal examinations. MATERIALS AND METHODS: Between November 1995 and October 1997, 95 patients who had serum PSA levels of 4.0 to 10.0 ng/ml with normal digital rectal examinations were prospectively evaluated. All patients underwent one or two times transrectal ultrasound guided prostate biopsies. Based on age specific reference range of PSA, PSA density and % free PSA ratio, PMI was calculated for each patient. The free and total serum PSA concentrations were determined by an Immulite assay system. (Diagnostic Product Corp., Los Angeles, California). RESULTS: Overall 20 of 95 (21%) patients had prostate cancer. There were no significant differences in patient mean age and mean total PSA between those with benign and those with malignant biopsies (p>0.05). However, there were significant differences in mean PSAD, mean free-to-total PSA ratio and mean PMI (p<0.01, p<0.05, p<0.01, respectively). Benign condition specificities for PM index, percent free PSA, PSA density and total PSA at a 90% sensitivity for prostate cancer were 48%, 10.6%, 8% and 4%, respectively. Of 95 patients, 27 (28.4%) had a PMI of equal or more than 3.1, including 12 of 75 (16%) with negative biopsy and 15 of 20 (75%) with positive biopsy. Furthermore a cutoff MI 0.86 P correctly identified 24% of benign cases without missing any prostate cancer cases. The comparison of receiver operating characteristic (ROC) curve areas showed that PMI was better than total PSA (p<0.01). Although, the area under the ROC curve of % free PSA and PSAD were higher than the area of total PSA, these differences were not statistically significant (p>0.05). CONCLUSIONS: We concluded that the prostate malignancy index could be utilized to differentiate benign conditions from prostate cancer in patients with intermediate PSA levels and normal digital rectal examination. Also significant numbers of negative biopsies can be prevented in these patients.

Effect of laser prostatectomy on the serum prostate-specific antigen concentration: results of a prospective study.

OBJECTIVE: To assess the effect of the laser prostatectomy (LP) procedure on the serum prostate-specific antigen (PSA) levels. PATIENT AND METHODS: The serum PSA level was determined in 41 patients with benign prostatic hyperplasia 1 day before and 1, 3, 7, 15, 30, and 90 days after LP. All patients underwent preoperative evaluation with routine blood tests, serum PSA level, IPSS symptom questionnaire, intravenous pyelography, uroflowmetry, postvoid residual urine measurements, and transrectal ultrasonography (TRUS). IPSS symptom questionnaire, uroflowmetry, postvoid residual urine measurements, and TRUS were repeated 3 months after LP. RESULTS: PSA levels showed a statistically significant increase 24 h after LP, then a slow decrease and by 1 month the PSA levels had returned to their initial levels. A statistically significant positive correlation was found between the PSA level 24 h after LP and the amount of energy applied to the prostate during operation (r 0.87, p < 0.0001). After 30 and 90 days the mean PSA values were under the preprostatectomy concentration. The mean PSA values at 30 and 90 days were statistically significantly lower than those measured before treatment (p < 0.05). There was a statistically significant positive correlation between the reduction in PSA and the reduction in prostate weight 3 months after LP. CONCLUSION: This study showed that LP produced a variable rise in PSA, with a peak rise in PSA occurring 24 h after the procedure. In some patients, the serum PSA returned to baseline by 15 days. But, after 15 days the mean PSA level was still greater than the preprocedure value. Therefore, we recommend that blood should not be sampled for PSA for at least 30 days after LP. The mean PSA levels 30 and 90 days after treatment were lower compared with the preoperative levels. This low level of PSA can probably indicate a reduction in prostate volume following LP.

Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

Fracture of the penis.

Fracture of the penis is a rare condition. The fracture is easy to recognize but treatment remains controversial. Between December 1991 and January 1997, eleven patients underwent emergency operation on the first day after penile fracture. Our operative plan consisted of immediate exploration, identification, debridement and primary repair of the tear in the tunica albuginea. The patients' mean age was 27 years (range 21-38 yrs.). Penile fracture was due to sexual manoeuvres in 8, manipulation in 2 and fall onto erect penis in one of 11 patients. The mean hospitalization time was 2.2 days (range 1 to 3 days). There was no significant early postoperative complication except wound infection in one patient. In the first postoperative month, there was a residual fibrosis due to nonabsorbable sutures in one patient and mild pain during coitus in the other one. All patients had full erection and no patient needed additional treatment. To avoid serious complications and preserve penile functions immediate surgical intervention is recommended.

Urological evaluation of Behçet patients and the effect of colchicine on fertility.

Behçet's disease is a multisystem disorder in which urogenital involvement mainly consists of genital aphthous ulcers, epididymitis, urethritis and recurrent cystitis. Colchicine is commonly used in these patients for the prevention of arthritic episodes. In this prospective study, 62 male patients under colchicine therapy for Behçet's disease underwent a complete urogenital evaluation. 33 (53.2%) had no urologic complaints. Physical examination revealed genital aphthous ulcers in 42 patients (67.7%) and epididymitis in 5 (8.1%). Analysis of urine specimens demonstrated proteinuria in 54.8% and hematuria in 30.6%. To establish any possible adverse effects of colchicine administration on male fertility, sperm analysis was performed: 23 patients (37.1%) had oligonecrospermia, 2 patients (3.2%) had azoospermia. Penile color flow Doppler sonography revealed arterial insufficiency in 17 patients (27.4%). Other urological findings were interpreted as coincidental. Our results indicate that urologic manifestations of Behçet's disease, and especially the possible adverse effects of colchicine administration on the reproductive potential of the treated patients should be carefully monitored.

Extracorporeal shockwave lithotripsy in anomalous kidneys.

Traditionally, stones in anomalous kidneys have been removed by open or percutaneous surgery. Extracorporeal shockwave lithotripsy (SWL) with the Dornier MPL 9000 lithotripter was performed in seven patients with horseshoe kidneys, four with pelvic ectopic kidneys, and six with malrotated kidneys. Twelve patients (71%) needed repeated treatments. A total of 11 patients (65%) in all the groups were stone free, and four patients had asymptomatic residual fragments no more than 5 mm in diameter. In the remaining two patients, no sign of stone disintegration was observed, and they underwent open surgery. Extracorporeal lithotripsy is the treatment of choice for stones in horseshoe or malrotated kidneys but is not useful for stones in most pelvic kidneys.

NAG, GGT, creatinine, urea and creatinine clearance before and after ESWL.

N-acetyl-beta glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in the urine and serum before, 24 hours and one week after extracorporeal shock wave lithotripsy in 25 patients. Although ESWL is the preferred method in the treatment of kidney stones, its effect on renal parenchymal cells has not been sufficiently elucidated. Since radiographic methods remain inadequate in the estimation and management of parenchymal damage, it is useful to establish the specific renal cell proteins in urine and serum, reflecting renal tubular cell destruction.

371 bladder calculi in a benign prostatic hyperplasia patient.

We describe a patient with 371 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.