Role of Aortic Stiffness in Predicting Response to Phosphodiesterase-5 Inhibitors in the Treatment of Erectile Dysfunction. / Papel da Rigidez Aórtica na Previsão da Resposta aos Inibidores da Fosfodiesterase-5 no Tratamento da Disfunção Erétil.

BACKGROUND: It is known that aortic stiffness (AS) increases in patients with erectile dysfunction (ED). Phosphodiesterase type-5 (PDE-5) enzyme inhibitors are used in the treatment of ED, and patients' responses to this treatment may vary. OBJECTIVES: We aimed to investigate the role of AS in predicting the response of patients planned to take PDE-5 enzyme inhibitors due to ED. METHODS: A total of 96 male patients with ED were included in the study. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate the presence and severity of ED and the response to treatment. Transthoracic echocardiography was used to evaluate AS. RESULTS: There was a statistically significant difference between the aortic strain and aortic distensibility values of the study groups (p<0.001). The delta IIEF score had a high level of positive correlation with aortic strain (p<0.01, r=0.758) and a moderate level of positive correlation with aortic distensibility (p<0.01, r=0.574). CONCLUSION: We determined that in patients with ED, aortic strain and aortic distensibility measured non-invasively using transthoracic echocardiography are important parameters in predicting patients' response to PDE-5 inhibitor therapy.

FUNDAMENTO: Sabe-se que a rigidez aórtica (RA) aumenta em pacientes com disfunção erétil (DE). Os inibidores da enzima fosfodiesterase tipo 5 (PDE-5) são usados no tratamento da DE, e as respostas dos pacientes a esse tratamento podem variar. OBJETIVOS: Nosso objetivo foi investigar o papel da RA na previsão da resposta de pacientes planejados para tomar inibidores da enzima PDE-5 devido à DE. MÉTODOS: Um total de 96 pacientes do sexo masculino com DE foram incluídos no estudo. O questionário do Índice Internacional de Função Erétil (IIEF) foi utilizado para avaliar a presença e gravidade da DE e a resposta ao tratamento. A ecocardiografia transtorácica foi utilizada para avaliar RA. RESULTADOS: Houve diferença estatisticamente significativa entre os valores de deformação aórtica e distensibilidade aórtica dos grupos de estudo (p<0,001). O escore delta IIEF apresentou alto nível de correlação positiva com a deformação aórtica (p<0,01, r=0,758) e um nível moderado de correlação positiva com a distensibilidade aórtica (p<0,01, r=0,574). CONCLUSÃO: Determinamos que em pacientes com DE, a deformação aórtica e a distensibilidade aórtica medidas de forma não invasiva por meio de ecocardiografia transtorácica são parâmetros importantes na previsão da resposta dos pacientes à terapia com inibidores da PDE-5.

Sexual Functions Following Cardiac Resynchronization Therapy: Evaluation of Male Patients and Their Partners.

INTRODUCTION: Sexual functionality, a critical component of health-related quality of life, can decline for various reasons, including heart failure (HF). Our purpose was to prospectively evaluate male patients with HF scheduled for cardiac resynchronization therapy (CRT) in terms of sexual function, erectile function, and alterations in hormonal and biochemical parameters. In addition, we sought to determine the sexual functioning of the partners of these patients. METHODS:  The study enrolled 103 male patients and their partners. The International Index of Erectile Function-5 (IIEF-5) was administered to all males and the Arizona Sexual Experience Scale (ASEX) questionnaire was completed by all participants, at baseline and three months after CRT. RESULTS:  The ASEX scores of patients and partners demonstrated significant declines from baseline to post-intervention analysis. The IIEF-5 scores of patients showed a significant increase from baseline to post-intervention (p=0.001 for all). CONCLUSION:  We conclude that sexual dysfunction is experienced by the partners of male patients with erectile dysfunction before CRT and that reversal of erectile problems with CRT yields improvements in both male and female sexual functions.

Effects of knee prosthetic surgery on overactive bladder symptoms and incontinence in women.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) and overactive bladder (OAB) are common conditions worldwide. These conditions significantly affect the quality of life (QoL) of patients with limited mobility. Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, resulting in pain relief, as well as improved function and QoL. This study was aimed at evaluating changes in patients' mobility as a result of TKA surgery and the effect of these changes on their OAB and UI symptoms. METHODS: A total of 49 female patients with stage IV osteoarthrosis were included in the study. The International Consultation on Incontinence Question-Short Form (ICIQ-SF), Overactive Bladder-Validated 8 (OAB-V8), Visual Analog Scale (VAS), and Oxford Knee Score (OKS) forms were completed pre-operatively and at the 6th post-operative month. Both knee flexion angles were measured, and the post-void residual urine volume (PVR) was recorded. RESULTS: A statistically significant (p<0.001) decrease was observed in the ICIQ-SF, VAS, OKS, and OAB-V8 scores in the post-operative period compared with the pre-operative values. No statistically significant change was detected in PVR (p=0.103). There was a statistically significant increase in the flexion angle (p<0.001). CONCLUSIONS: After knee arthroplasty, there was a noticeable improvement in the OAB symptoms and UI complaints of the patients. Therefore, we consider that increasing mobility after TKA will positively affect OAB/UI in female patients.

The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey.

Objectives: We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year. Methods: The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year. Results: While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased. Conclusion: During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients' admissions to the emergency and urology department, and in urologic surgeries.

Does two-piece PPI provide improvement in patient-partner quality of life?

OBJECTIVE: The aim of this study is to retrospectively examine patient-partner satisfaction and changes in quality of life due to two-piece penile prosthesis implantation (PPI). There is no data about partner Quality of Life (QoL) related to two-piece PPI in the literature. MATERIAL AND METHODS: SF 36 scale and modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), which were filled before two-piece PPI and at the sixth postoperative month follow-up by male patients (n = 45) and female partners (n = 45), were evaluated. RESULTS: We found patient-partner satisfaction rates as 80% and 86% respectively. The changes in all mean scores of SF 36 (mean total score, mean physical health score and mean mental health score) were statistically significant (p < 0.01). Again, the differences between all mean scores of SF 36 according to the level of patient-partner satisfaction were statistically significant (p < 0.01). CONCLUSIONS: Two-piece PPI is an important option for ED treatment. It provides significant improvement in patient-partner QoL with high treatment satisfaction.

Changes in the sexual functions of male patients and their partners after obesity surgery.

Sexual functionality significantly contributes to health-related quality of life and can decrease with obesity. In this study, we aimed to prospectively evaluate the changes that occur in the erection function, sexual function and testosterone level of male patients scheduled to undergo bariatric surgery, as well as the changes in the sexual function of their partner. A total of 40 patients and their partners were included. International Index of Erectile Function-5 (IIEF-5) questionnaire and the Arizona Sexual Experience Scale (ASEX) were filled before and 6 months after surgery by the male patients. The ASEX form was also completed by the partners before and 6 months after the procedure. The height and weight measurements and testosterone values were measured before and after surgery. A statistically significant difference was found between the preoperative and post-operative IIEF-5 scores of the patients (p = 0.000 < 0.01). There was also a statistically significant difference between the patients and their partners' preoperative and post-operative ASEX scores. We can conclude that the partners of men with preoperative erection complaints also experience sexual dysfunction, and with the post-operative decrease in or disappearance of erection complaints, the sexual function of both male patients and their partners improves.

Bipolar radiofrequency thermotherapy treatment of the prostate in urinary catheter-dependent men.

OBJECTIVES: In this study, for the first time in the literature, we evaluated patients with benign prostatic hyperplasia (BPH) who had undergone permanent urinary catheterization for urinary retention and who were treated with radiofrequency (RF) thermotherapy as an alternative method due to their inoperability based on the high risk associated with anesthesia. We aimed to investigate these patients' posttreatment parameters concerning the catheter-free rates, quality of life (QoL) changes, and retrospective treatment efficacy. METHODS: RF thermotherapy was applied to 62 permanent patients catheterized within the last 3 months due to urinary retention. The follow-up data of the patients were retrospectively analyzed. The patients who were free of catheters and those who required permanent catheterization were determined. The changes in the International Prostate Symptom Score (IPSS), QoL, postvoiding residue (PVR), and maximal flow rate (Qmax ) values were analyzed. RESULTS: A total of 52 patients were evaluated in terms of treatment success in relation to the elimination of the need for a urinary catheter, which was calculated as 73.07%. The Qmax , IPSS, QoL, and PVR values of 38 patients who no longer required a catheter were monitored for 24 months, and statistically significant changes were observed in all parameters. CONCLUSION: Bipolar RF thermotherapy was found to be beneficial for men dependent on catheters due to BPH. It can be recommended as a safe, minimally invasive treatment method for elderly patients with a high anesthesia risk.

Our Retroperitoneal Cystic Echinococcosis Surgery Experiences at Mehmet Akif Inan Training and Research Hospital in Sanliurfa

Objective: This study aimed to discuss the place of surgical technique in patients who were operated for retroperitoneal hydatid cyst at our clinic, in the light of current literature. Methods: Data from seven patients who were operated for retroperitoneal hydatid cyst between May 2012 and May 2019 were retrospectively collected and evaluated. Results: Two patients were operated for isolated retroperitoneal hydatid cyst, one for liver hydatid cyst accompanying renal hydatid cyst and four patients were operated only for renal hydatid cyst. Recurrence was not observed in the follow-up. Conclusion: In our study, emphasis was laid on the fact that cysts can be treated successfully by using total, subtotal and partial cystectomy methods based on the organ and tissue neighbourhood.

Our experiences in bipolar radiofrequency thermotherapy system as an alternative treatment in LUTS.

We aimed to evaluate the efficacy of the bipolar radiofrequency thermotherapy system as a minimally invasive treatment method in lower urinary tract symptom treatment and its effect on the patients' quality of life (QoL). The thermotherapy system was applied to 118 patients between May 2016 and September 2017 with the requirement of surgical treatment for benign prostatic hyperplasia, who either could not be operated upon due to their comorbidities or preferred to undergo this procedure as an alternative treatment method. The International Prostate Symptom Score (IPSS) and QoL scores and maximal flow rate (Qmax) and post-voiding residue (PVR) values were evaluated before and after treatment. For the 80 patients who completed the 2-year follow-up period, the Qmax values were observed to be increased at each follow-up evaluation and PVR, QoL and IPSS were observed to be decreased. These changes were statistically significant from the baseline. In this study we found there was 48.8% increase in Qmax, 72.1% decrease in IPSS, 70.8% decrease in the QoL score, 51.1% decrease in PVR of 80 patients who underwent bipolar radiofrequency prostate ablation. The bipolar radiofrequency prostate thermotherapy system can be safely applied as an outpatient treatment in high-risk cases or for those who are anxious about surgical interventions.

Sexual experiences between partners after penile prosthesis: Who is more satisfied?

Penile prosthesis implantation (PPI) is the final stage treatment in erectile dysfunction (ED). In this study, we planned to investigate the effect of PPI application on sexual functionality in the patients and their partners. After taking permission and consent for the study, from 20 male patients who were applied penile prosthesis due to ED between March 2013 and June 2018 and their partners, the couples were included in the study. Patients and partners filled in Arizona Sexual Experiences Scale (ASEX) form before PPI. After starting to use prosthesis, 20 patients and 19 partners were asked to fill in modified EDITS and ASEX form in the follow-ups in the sixth month. Average age was 54.35 years for the patients and 43.84 for the partners. Although post-PPI sexual satisfaction ratio was detected higher in female partners compared with the male patients, this difference was not statistically significant (p = .71). A significant recovery was also observed in total scale score, physiological stimulation, orgasm capacity and satisfaction scores in both groups after PPI. Penile prosthesis implantation is an operation providing high satisfaction for both the partner and the patient and is still one of the best options of ED.

Is there any effect of insulin resistance on male reproductive system?

OBJECTIVES: To investigate the possible effect of insulin resistance (IR) on male reproductive system via evaluation of semen analysis, male sex hormones and serum lipid profiles, and testicular volumes. METHODS: After the exclusions, a total of 80 male patients were enrolled in this prospective study. Body Mass Index (BMI), Testicular volume, semen samples, serum hormone/lipid profiles, high sensitive C-Reactive Protein (hsCRP) were obtained from all the subjects. RESULTS: The patients were divided into two groups as study and control according to the presence of IR. There were no statistical differences in terms of age, marriage period, testicular volume, serum levels of hormone and lipid profiles and BMI between the groups. There were no relationship between homeostasis model assessment of insulin resistance (HOMA-IR) and semen volume (r = -0.10, p = 0.37), total sperm count (r = -0.09, p = 0.39), motility (r = -0.15, p = 0.16) and morphology (r = -0.14, p = 0.19). However, HOMA-IR was closely associated with hsCRP levels (r = 0.94, p < 0.0001). CONCLUSIONS: Despite of the documented strong inverse relationships between Diabetes Mellitus (DM) and male/female fertility, and also between IR and female infertility via ovarian functions as in polycystic ovary syndrome, to our knowledge, there is no report about any influence of IR on male fertility. DM and metabolic syndrome (MetS) have negative influence on fertility. Thus, IR may be accused of causing detrimental effect on male infertility due to hyperinsulinemic state and being one of the components for MetS. Interestingly, due to our preliminary results, we do not found any inverse correlation between IR and male reproductive functions.

Amputation of the penis and bilateral orchiectomy due to extensive debridement for Fournier's gangrene: case report and review of the literature.

Fournier's gangrene is a rare disease with rapidly progressive necrotising fasciitis of the genital, perineal and perianal regions and is known to have an impact in the morbidity and the mortality. Despite antibiotics and aggressive debridement, mortality rate is still high. We present a 79-year-old man who was admitted to School of Medicine, Harran University, Sanliurfa, Turkey, with painful swelling of penoscrotal region. Perineal examination revealed the entire perineal skin to be gangrenous, necrotic and foul smelling. Despite the aggressive drainage and broad-spectrum antibiotic therapy, the gangrene progressed rapidly in hours and the patient's general condition worsened. Secondary extensive debridement including bilateral orchiectomy and amputation of the penis was performed. This disease may result in loss of organ such as testes and penis even with sufficient therapy.

The Relations between Enuresis in Childhood and Nocturnal Polyuria Syndrome in Adult Life.

PURPOSE: The aim of this study, to investigate whether there is any association between enuresis in childhood and nocturnal polyuria syndrome (NPS) in adult life. METHODS: The study consisted of thirty five patients with nocturnal polyuria, and thirty five healthy people without nocturnal polyuria in adult life, were asked to assess their enuresis in childhood. RESULTS: There was a history of enuresis in childhood in 18 (51.42%) of 35 of men with nocturnal polyuria and in 4 (11.42%) of 35 without nocturnal polyuria. Enuresis in childhood was significantly more common in men with nocturnal polyuria than without nocturnal polyuria. The difference was significant (P<0.0001). The prevalence of enuresis in the nocturnal polyuria (51.42%) was more than two-fold higher than reported prevalence in general populations. CONCLUSIONS: The results of this study suggest that the history of enuresis in childhood seems to increase the risk of having NPS in adult life. This relationship should be taken into account in the evaluation of men with complaints from NPS in adult life and the possible common pathophysiology should be considered in the treatment planning.

Serum paraoxonase activity in patients with low glomerular filtration rates.

OBJECTIVE: Epidemiological and experimental studies indicate that kidney disease is associated with increased oxidative stress. Our aim was to determine whether paraoxonase 1 (PON1) activity is altered in patients with moderately decreased glomerular filtration rates (GFRs) compared to healthy controls. MATERIAL AND METHODS: Forty-eight patients showing relatively low GFRs upon renal scintigraphy with (99m)Tc-DTPA were compared to 40 age-matched healthy subjects. Serum PON1 activity was measured spectrophotometrically. Lipid hydroperoxide levels were measured via iodometric assay. RESULTS: The mean ages of the patient and control groups were 32.09 +/- 6.10 (range 23-50) and 31.30 +/- 5.30 (range 20-46) years, respectively. Serum PON1 (p= 0.949) and high-density lipoprotein (p= 0.473) levels did not differ between groups. Significant differences were detected between groups in terms of mean triglyceride (p= 0.009), very-low-density lipoprotein (p = 0.010), lipid hydroperoxide (p = 0.026), urea (p = 0.012), and creatinine (p = 0.001) levels, whereas total cholesterol (p = 0.520) and low-density lipoprotein (p = 0.161) were similar between groups. Mean GFR was significantly lower in the low GFR group compared to the control (p = 0.000). CONCLUSION: Our results indicate that PON1 activity and high-density lipoprotein levels may not be determining factors in premature vascular aging in patients with moderately decreased GFRs. Instead, some other undetermined factor(s) may be involved in modulating enzymatic activity.

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction.

OBJECTIVES: To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity. METHODS: Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate. RESULTS: Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1+0.0 vs. 1.6 + 0.0 umol H2O2 Eq/L, 10.3+1.1 vs. 6.9 + 1.2 umol H2O2 Eq/L, and 236.4+19.5 vs. 228.2 + 19.2 U/L, respectively (p < 0.0001 for all). CONCLUSIONS: Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction

OBJECTIVES: To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity. METHODS: Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate. RESULTS: Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1+0.0 vs. 1.6 + 0.0 umol H2O2 Eq/L, 10.3+1.1 vs. 6.9 + 1.2 umol H2O2 Eq/L, and 236.4+19.5 vs. 228.2 + 19.2 U/L, respectively (p<0.0001 for all). CONCLUSIONS: Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.