The effect untreated right subclinical varicocele on the outcomes of contralateral left clinical varicocelectomy in infertile patients.

PURPOSE: The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA). MATERIALS AND METHODS: Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up. RESULTS: The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations. CONCLUSIONS: Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.

The prevalence and topographic distribution of penile calcification in a large cohort: a retrospective cross-sectional study.

The prevalence of penile calcification in the population remains uncertain. This retrospective multicenter study aimed to determine the prevalence and characteristics of penile calcification in a large cohort of male patients undergoing non-contrast pelvic tomography. A total of 14 545 scans obtained from 19 participating centers between 2016 and 2022 were retrospectively analyzed within a 3-months period. Eligible scans (n = 12 709) were included in the analysis. Patient age, penile imaging status, presence of calcified plaque, and plaque measurements were recorded. Statistical analysis was performed to assess the relationships between calcified plaque, patient age, plaque characteristics, and plaque location. Among the analyzed scans, 767 (6.04%) patients were found to have at least one calcified plaque. Patients with calcified plaque had a significantly higher median age (64 years (IQR 56-72)) compared to those with normal penile evaluation (49 years (IQR 36-60) (p < 0.001). Of the patients with calcified plaque, 46.4% had only one plaque, while 53.6% had multiple plaques. There was a positive correlation between age and the number of plaques (r = 0.31, p < 0.001). The average dimensions of the calcified plaques were as follows: width: 3.9 ± 5 mm, length: 5.3 ± 5.2 mm, height: 3.5 ± 3.2 mm, with an average plaque area of 29 ± 165 mm² and mean plaque volume of 269 ± 3187 mm³. Plaques were predominantly located in the proximal and mid-penile regions (44.1% and 40.5%, respectively), with 77.7% located on the dorsal side of the penis. The hardness level of plaques, assessed by Hounsfield units, median of 362 (IQR 250-487) (range: 100-1400). Patients with multiple plaques had significantly higher Hounsfield unit values compared to those with a single plaque (p = 0.003). Our study revealed that patients with calcified plaques are older and have multiple plaques predominantly located on the dorsal and proximal side of the penis.

Effects of long term sildenafil on the acute phase of Peyronie's disease in a combination treatment.

OBJECTIVES: The aim of this study was to investigate the impact of the addition of 50 mg daily sildenafil to pentoxifylline-colchicine combination ther-apy on the Peyronie's plaque features in patients with the acute phase of Peyronie's disease (PD). METHODS: In this retrospective and non-randomized clinical study, patients were divided into 2 groups as group 1; (n = 107) who received colchicine and pentoxyfillin plus 50 mg daily oral sildenafil, and as group 2; (n = 79) who received only colchicine and pentoxyfillin. Patients were compared in terms of degree of curvature, pain in erection and erectile function at the baseline and at 6-month follow up. Pain in erection and erectile func-tion were evaluated by visual Analogue Scale (EF-VAS), and the shortened version of the International Index of Erectile Function (IIEF-5). Improvement in the degree of curvature and change in EF-VAS scores were primary endpoints of the study. Change in IIEF-5 score was the secondary endpoint of the study. RESULTS: The two groups were statistically similar in terms of demographics and baseline features of PD. A statistically signifi-cant reduction in degree of curvature and EF-VAS scores was shown in group 1 compared to group 2.There was also a signifi-cantly higher IIEF-5 score in group 1 compared to group 2. No significant side effects were detected in both groups during treatment period. CONCLUSIONS: Adding sildenafil to pentoxifylline-colchicine com-bination treatment seems to improve PD related symptoms in the acute phase PD. PDE5i may contribute to relieve the Peyronie's symptoms in ED patients through their antifibrotic effects.

Whether Adding Vitamin D to Tadalafil 5 mg Treatment Is Useful in Patients with Erectile Dysfunction and Vitamin D Deficiency?

INTRODUCTION: Numerous factors such as endothelial disease and hormonal disorder cause the development of erectile dysfunction (ED). However, the relationship between vitamin D deficiency (VDD) and ED is unclear. Moreover, the benefit of vitamin D replacement on ED patients with VDD is uncertain. As far as we know, there is no study yet in the literature regarding the addition of vitamin D to phosphodiesterase type 5 inhibitors in the treatment of ED patients with VDD. In this study, we investigated whether adding vitamin D to daily tadalafil treatment would be beneficial in ED patients with VDD. METHODS: A total of 111 patients with VDD accompanying ED were retrospectively evaluated between January 2016 and December 2019. Patients were divided into 2 groups according to the treatment they received. Group 1 (n = 58) was treated with daily oral tadalafil 5 mg, while group 2 (n = 53) received oral tadalafil 5 mg and 4,000 IU vitamin D3. Total International Index of Erectile Function-15 (IIEF-15) scores and vitamin D levels of the groups were compared at the end of the study. RESULTS: The mean vitamin D level was increased statistically significant in group 2, but no difference was seen in group 1 (p < 0.001 and p > 0.05, respectively). There was a significant increase in median erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall satisfaction scores in both groups (p < 0.001). However, the increase in median erectile function and sexual desire scores was significantly higher in group 2 compared to group 1 at the end of the study (p = 0.01 and p < 0.001, respectively). CONCLUSION: We found that adding vitamin D to 5 mg oral daily tadalafil treatment may have an additional positive effect on erectile function and sexual desire in ED patients with VDD.

Is there any relationship between serum levels of total bilirubin and the severity of erectile dysfunction?

OBJECTIVE: Recent studies have shown that atherosclerosis is associated with erectile dysfunction and the serum bilirubin level. In this study, the serum total bilirubin levels of patients with erectile dysfunction were measured to investigate the relationship between the levels of erectile dysfunction and total bilirubin. METHODS: A total of 94 patients with erectile dysfunction were divided into three groups; severe erectile dysfunction (33 patients), moderate erectile dysfunction (31 patients), and mild erectile dysfunction (30 patients). In addition, a control group was formed with 31 healthy men. The International Index of Erectile Function-5 Questionnaire was used to measure the quality of erection in all the groups. The body mass index was calculated for all the participants. The serum glucose, low-density lipoprotein and high-density lipoprotein, cholesterol, triglyceride, total bilirubin, and total testosterone levels were also determined. RESULTS: No statistically significant difference was observed between the groups in terms of the mean age, hypertension, smoking status, alcohol use, cardiovascular diseases, hepatobiliary disease, diabetes mellitus, and levels of total testosterone, low-density lipoprotein-cholesterol, and triglyceride. However, high-density lipoprotein, body mass index, and total bilirubin were significantly lower compared to the control group (p < 0.001). The serum total bilirubin level was found to be 0.41 ± 0.21 ng/dL in the severe erectile dysfunction, 0.43 ± 0.19 ng/dL in the moderate erectile dysfunction, and 0.48 ± 0.11 ng/dL in the mild erectile dysfunction groups (p < 0.001). CONCLUSION: Considering the significant differences between the erectile dysfunction and control groups in terms of serum total bilirubin levels, a low level of bilirubin may have a role in the etiology of erectile dysfunction.

Evaluation of Heat Transfer to the Implant-Bone Interface During Removal of Metal Copings Cemented onto Titanium Abutments.

PURPOSE: The aim of this investigation was to measure the temperature increase due to heat transferred to the implant-bone interface when the abutment screw channel is accessed or a metal-ceramic crown is sectioned buccally with diamond or tungsten carbide bur using an air rotor, with or without irrigation. MATERIALS AND METHODS: Cobalt-chromium copings were cemented onto straight titanium abutments. The temperature changes during removal of the copings were recorded over a period of 1 minute. RESULTS: The sectioning of coping with diamond bur and without water irrigation generated the highest temperature change at the cervical part of the implant. CONCLUSION: Both crown removal methods resulted in an increase in temperature at the implant-bone interface. However, this temperature change did not exceed 47°C, the potentially damaging threshold for bone reported in the literature.

Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy.

PURPOSE: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy (NSRP) due to localized prostate cancer (PCa). MATERIALS AND METHODS: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. RESULTS: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6th month follow-up (p > 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). CONCLUSIONS: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.

Penile degloving and dorsal dartos flap rotation approach for the management of isolated penile torsion.

OBJECTIVE: Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the outcomes of penile degloving and dorsal dartos flap rotation used for the repair of isolated penil torsion. MATERIAL AND METHODS: During evaluation of the patients admitted to our polyclinic for circumcision between January 2013-December 2014, 5 cases of isolated penile torsion were determined. Following the circumcision procedure performed with bipolar cautery, patients undergoing penile degloving were checked whether penile torsion was relieved or not. In case of insufficient improvement, torsion was corrected with application of dorsal dartos flap. Penile torsion was corrected with dartos flap in 2, and penile degloving in 3 cases. RESULTS: The mean age of the patients was 5.6 years (4-7), and the mean operative time 12 minutes (7-20), respectively. The mean operation time was 17.5 (15-20) minutes and 8.3 (7-10) minutes in the dorsal dartos flap and penile degloving groups, respectively. The preoperative mean degree of penile torsion was 50° (30°-70°). The mean degree of torsion was 65° and 40° in the dorsal dartos and penile degloving groups, respectively. During the postoperative follow up, 1 case of residual torsion (<10°) was observed in the dorsal dartos flap group. Residual torsion was not observed in other patients. CONCLUSION: Exploration for isolated cases of penile torsion during the circumcision procedure should not be overlooked. Successful results can be obtained with penile degloving and dartos flap rotation in cases with low and moderate torsion.

Orexin expression in different prostate histopathologic examinations: Can it be a marker for prostate cancer? A preliminary result.

OBJECTIVE: The aim of this study was to evaluate the expression of the orexin receptor in different prostate pathologies, including prostate adenocarcinoma, benign prostate hyperplasia and chronic prostatitis. MATERIAL AND METHODS: A total of 90 patients (mean age 64.01±7.2 years) were enrolled in the study. The patients were divided into three groups of equal numbers based on their histopathologic findings: prostate cancer (Group 1), benign prostate hyperplasia (Group 2) and chronic prostatitis (Group 3). All the tissues were incubated with a primary antibody recognizing the Orexin receptor. The specific cytoplasmic immunoreactivity of the Orexin receptor was semiquantitatively scored for intensity and distribution based on a grading scale. The staining intensity and orexin expression were evaluated using Pearson χ(2) test. RESULTS: A heterogeneous staining pattern of the Orexin receptor was observed between the groups. The expression rates were 90% (27/30) in Group 1, 53.3% (16/30) in Group 2 and 26.7% (8/30) in Group 3. While 5 patients (9.3%) in Group 1 showed strong staining, all samples from the other 2 groups showed only weak staining. There were significant differences in staining intensity between the three groups. The expression and distribution of the Orexin receptor was more widespread in Group 1 than in the other groups and was higher in patients with poorly differentiated malignancy. However, there was no significant difference based on Gleason score. CONCLUSION: Orexin receptors are found in human prostate tissues and their expression is widespread in prostate cancer and in patients with a higher Gleason score. Therefore, we believe that Orexin immunoreactivity can be considered to be an indicator of poor prognosis and of poorly differentiated prostate cancer cases.

Role of testosterone/estradiol ratio in predicting the efficacy of tamoxifen citrate treatment in idiopathic oligoasthenoteratozoospermic men.

AIM: It was the aim of this study to investigate the effect of a low testosterone/estradiol (T/E2) ratio and the normalization of this ratio by an aromatase inhibitor, anastrozole, on the treatment results of tamoxifen citrate (TAM) in idiopathic oligoasthenoteratozoospermic patients with a normal T/E2 ratio. PATIENTS AND METHODS: 127 normogonadotropic men were included in this study. TAM (10 mg twice daily) was applied to 103 of the patients (group 1). The control group consisted of 25 patients who did not receive any treatment (group 2). After 3 months, TAM therapy was continued in 42 of the patients with a normal T/E2 ratio (group 1A). Of the remaining 61 patients with low ratios, 30 continued with TAM (group 1BTAM), while the remaining 31 patients underwent additional anastrozole therapy (1 mg/day) to TAM (group 1BANA). RESULTS: In the 3rd month of the study, while the sperm concentration and motility were found significantly improved in group 1 (p < 0.05), they were significantly lower in groups 1BTAM and 1BANA than in group 1A (p < 0.01). In the 6th month of the study, the mean T/E2 ratio was normal in group 1A and group 1BANA, but was lower than normal ranges in group 1BTAM. The sperm concentration and motility significantly increased in groups 1A and 1BANA (p < 0.05). CONCLUSIONS: A significant decrease in the T/E2 ratio was seen in the majority of the patients during TAM treatment. Normalization of this ratio by addition of anastrozole to the treatment regimen improved the treatment outcomes. However, a placebo-controlled study is needed to confirm our results.

Is there any additional benefit of venous diameter and retrograde flow volume as measured by ultrasonography to the diagnosis of suspected low-grade varicoceles?

AIMS: To investigate the relation between the findings of physical examination and ultrasonography and to evaluate whether venous diameter (VD) and retrograde flow volume (RFV) have any additional benefit to the diagnosis of suspected low-grade varicoceles. METHODS: Five hundred and fifty-two patients who applied to our outpatient clinic due to infertility were assessed by physical examination (PE) and B-mode and color Doppler ultrasonography (CDUS). The correlation of VD and RFV with clinical grade and with each other was investigated in cases diagnosed as unilateral left varicocele. RESULTS: Unilateral left varicocele was detected in 184 (33.3%) of 552 patients: mean VD of the subjects was 3.17 +/- 1.02 mm and mean RFV in 160 patients with a reflux was 24.01 +/- 13.76 ml/min. There was a correlation of clinical grade both with VD and RFV (r = 0.669, p < 0.001 and r = 0.603, p < 0.001, respectively). Considering VD and RFV, there was a significant difference between grade (G)1-G2 and G2-G3 (p < 0.001, p < 0.001, respectively) except between subclinic-G1 varicocele groups (p = 0.626, p = 0.529, respectively). The best cut-off point predicting the palpable varicocele on physical examination was 3.1 mm (sensitivity 58.2%) for VD and 14.5 ml/min (sensitivity 83.8%) for RFV. CONCLUSIONS: Measurement of RFV is more sensitive than that of VD in predicting palpable varicocele. However, neither of them seem to have any additional benefit to PE in clarifying the diagnosis of suspected low-grade varicoceles.

Shear bond strength of brackets bonded to amalgam with different intermediate resins and adhesives.

The aims of this study were to compare, in vitro, the shear bond strength (SBS) of stainless steel orthodontic brackets bonded to silver amalgam with the use of three different intermediate resins and two different adhesives, and to evaluate bond failure mode. Forty-five amalgam specimens were divided into three equal groups. In groups 1 and 2, the brackets were bonded with Unite (3M Unitek) using Reliance Metal Primer (RMP; Reliance Orthodontic Products) and Power Bond OLC (PB OLC; Ortho Organizers Inc.) as intermediate resins, respectively. In group 3, Resinomer and One-Step Plus (OS+; Bisco Inc.) were used. Thirty bovine teeth served as the controls to test bracket bonding to acid-etched enamel with Unite and Resinomer-OS+. After thermocycling from 10 to 50 degrees C 1000 times, all samples were tested for SBS. Bond failure sites were classified using a modified adhesive remnant index (ARI) system. Data were analyzed with one-way analysis of variance, post hoc Tukey multiple comparison and chi-square tests. The results showed that the mean SBS to amalgam surfaces were significantly lower than those to etched bovine enamel (P<0.001). There were no statistically significant differences in mean SBS between the amalgam bonding groups (P>0.05). For the ARI, significant differences were found between the amalgam- and enamel-bonding groups (P<0.001). The mean SBS of stainless steel orthodontic brackets bonded to amalgam surfaces with RMP, PB OLC, OS+ intermediate resins and Unite and Resinomer adhesives was significantly lower than to etched bovine enamel. Bond failure occurred at the amalgam-adhesive interface regardless of the adhesive system and without damage to the amalgam restoration.

Effect of naloxone on oxidative stress and testicular injury due to spermatic vessel ligation of rat testis.

AIMS: Two-stage Fowler-Stephens orchiopexy has been accompanied by testicular atrophy in some cases but neither of the mechanisms responsible for testicular injury are clear, nor is there an effective agent that might prevent this injury. In this study we aimed to investigate the long-term effects of naloxone, a morphine antagonist, on testicular histopathology and oxidative stress after spermatic vessel ligation (SVL) in rats. METHODS: 32 prepubertal rats were randomly divided into four equal groups: group 1: control (only bilateral orchiectomies were performed); group 2: sham-operated group; group 3: SVL, and group 4: SVL+naloxone (1 mg/kg twice daily for 1 month). One month postoperatively, bilateral orchiectomies were performed to evaluate histopathologic findings and measurement of malondialdehyde (MDA) and nitric oxide (NO) levels. RESULTS: Considering group 3, left SVL resulted in significant tissue damage in both testes, more severe in the ipsilateral testis. The SVL resulted in a significant increase in testicular MDA levels of both testes in this group (p < 0.05). While the ipsilateral testicular NO levels of groups 2 and 3 were significantly lower than of group 1 (p < 0.05), the contralateral testicular NO levels of all these groups were similar. After naloxone therapy, while there was no significant improvement in ipsilateral testicular histopathology (p > 0.05), the contralateral testicular histopathology improved significantly (p < 0.05). However, naloxone did not change either testicular MDA or NO levels. CONCLUSIONS: The SVL led to bilateral testicular injury, and oxidative stress may be a reason for this injury. Naloxone significantly improved contralateral testicular injury without showing any antioxidative effect.

Results of varicocelectomy in patients with isolated teratozoospermia.

INTRODUCTION: Isolated teratozoospermia is rarely encountered in patients with clinically palpable varicocele, and the consequences of varicocelectomy remain unclear in these cases. In the current study, we assessed the effect of varicocelectomy on sperm morphology in a series of patients with infertility. MATERIALS AND METHODS: The data obtained from 52 primary subfertile men with isolated teratozoospermia and clinical palpable varicocele were reviewed retrospectively. Varicocelectomy was performed on 29 patients, and the remaining 23 patients did not undergo any treatment (control group). The differences in sperm morphology assessed by using Kruger's strict criteria 3 months before and 12 months after varicocelectomy were taken into consideration for statistical analysis. RESULTS: One patient who underwent varicocelectomy was excluded from the study due to varicocele recurrence. Thus, data obtained from the remaining 28 patients were evaluated. Following varicocelectomy, significant improvement was detected in the ratio of normal sperm forms (p < 0.001). While there was significant improvement in the ratio of sperm cells with head defects, tail defects and immature forms (p < 0.001), the ratio of sperm with acrosome and mid-piece defects was not changed (p > 0.05). While an overall spontaneous pregnancy was achieved in 5 of the 28 (17.8%) couples in the varicocelectomy group within 12 months after operation, neither improvement in sperm morphology nor pregnancy in the patients' partners was detected in the control group. CONCLUSION: Varicocelectomy caused a significant improvement in sperm morphology, particularly in immature forms and forms with head and tail defects evaluated by Kruger's classification.

The association between personal habits and bladder cancer in Turkey.

AIMS: In this study, we analyzed the effect of Turkish coffee and black tea consumption, alcohol intake and smoking on bladder cancer. METHODS: A total of 164 patients with bladder tumors and 324 individuals without primary tumors were included in the study. The habits of coffee and tea consumption, alcohol intake and smoking were queried. RESULTS: No association was found between bladder cancer and drinking coffee (p=0.89) and tea (p=0.37), but alcohol intake was found to be associated, with an odds ratio (OR) of 1.85 (95% CI 1.15-2.96; p=0.009). While there was a relationship between bladder cancer and smoking and quitting smoking (OR: 4.84 [95% CI 2.93-8.00; p<0.001] and OR: 4.10 [95% CI 2.41-6.97; p<0.001] respectively), the associations between bladder cancer and smoking and quitting smoking were similar (OR: 1.18, 95% CI 0.74-1.86; p=0.477). Smoking<10 cigarettes a day created an OR of 2.14 (95% CI 1.11-4.12; p<0.001); 10-20 cigarettes an OR of 4.50 (95% CI 2.74-7.37; p<0.001); >20 cigarettes an OR of 14.85 (95% CI 6.83-32.27; p<0.001); smoking by inhaling the smoke an OR of 4.72 (95% CI 2.94-7.59; p<0.001), and smoking by not inhaling the smoke an OR of 3.34 (95% CI 1.75-6.38; p<0.001). The associations between bladder cancer and inhaling smoke and not inhaling smoke were similar (OR: 1.41, 95% CI 0.85-2.48; p=0.228). CONCLUSION: We found that smoking and alcohol consumption are closely connected with bladder cancer. Our data showed that not inhaling the smoke was as much associated with bladder cancer as inhaling the smoke. The association between smoking and bladder cancer lasts after quitting smoking.

Circumcision with a new disposable clamp: is it really easier and more reliable?

PURPOSE: To compare the results of a new disposable clamp (SCD) used for routine circumcision in our department, compared with the conventional dissection tecnique (CDT) in infants and children. METHODS: The SCD and CDT were evaluated prospectively, in terms of the duration, complication rate and postoperative pain assesment. The cosmetic result and parents' satisfaction were evaluated after 6 weeks. A total of 200 boys were included in the study (with a median age of 4.45 years). RESULTS AND CONCLUSIONS: The median operative duration was 10 min less for the SCD (18 vs 8 min; P < 0.001). There was no difference in complication rates for both groups. The cosmetic results assessed by a blinded urologist were better for the SCD group (P < 0.001). The parents' satisfaction score for the procedure was similar in both groups, as 8 out of a scale up to 10 filled in by the parents. Circumcision with the SCD is quicker and leads to a better cosmetic results than with the CDT, without increasing morbidity.

Surgical treatment of Peyronie's disease: a single center experience with 145 patients.

OBJECTIVES: To assess the outcomes of the surgical techniques used in Peyronie's disease (PD) surgery. PATIENTS AND METHODS: One hundred fifty patients received surgical treatment for PD. Fifteen and 75 patients underwent simple corporoplasties and incision of the plaque, and venous (IV) grafting, respectively, whereas 60 patients with erectile dysfunction underwent penile prosthesis implantation. At follow-up, the erectile function and penile deformity were assessed at 3 and 12 mo postoperatively, and every 6 mo thereafter. RESULTS: Postoperative results were satisfactory in 14 of 15 patients with simple corporoplasties, with a mean angle of deformity and follow-up of 51.0 degrees +/-14.9 degrees and 21.0+/-9.7 mo, respectively. Among patients undergoing IV grafting with sapheneous vein (mean curvature angle: 61.6 degrees +/-19.5 degrees ), 70 were regularly seen with a mean follow-up of 41.7+/-35.1 mo. Penile curvature was completely straightened in 53 (75.7%) patients, whereas 12.8% and 11.4% had residual curvature less than 20 degrees and more than 20 degrees , respectively. The mean degree of penile curvature of patients with penile prosthesis was 46.9 degrees +/-20.1 degrees . Straightening of the penis was accomplished with implantation of the prosthesis only, manual modeling, plaque incision and grafting (autologous rectus fascia in the majority), incision of the plaque, and penile plication in 35%, 30%, 33.3%, 1.6%, and 1.6%, respectively. In the prosthesis group, two patients had recurrent curvatures. CONCLUSIONS: IV grafting is a good option with satisfactory mid- and long-term outcome. Insertion of the prosthesis only and manual modeling correct the curvature in the majority of the patients. For the remaining patients, autologous rectus fascia is an appropriate graft material.

The clinical characteristics of Peyronie's patients with notching deformity.

INTRODUCTION: Peyronie's patients with notching deformity represent a small percentage of disease population, and the features of these patients have not been well established yet. AIM: To analyze the characteristics of Peyronie's patients with notching deformity. MAIN OUTCOME MEASURES: Peyronie's patients with notching deformity were compared with those with other type of penile deformities with regard to clinical features. METHODS: During a 13-year period, a total of 703 patients with Peyronie's disease were evaluated at our institution. The patients were divided into two groups: group I consists of Peyronie's patients with notching deformity (N = 89) and group II patients with any other kind of penile curvature (N = 614). The clinical characteristics, presence of co-morbidities including diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hypertension, and ischemic heart disease, erectile status, and penile deformities were compared between the two groups. RESULTS: Pure notching deformity was detected in 12.6% (N = 89) of the patients. The mean age of men was 53.1 +/- 10.2 and 52.7 +/- 10.7 years in groups I and II, respectively, (P = 0.8). The leading presenting symptom was erectile dysfunction (68.5%), followed by penile deformity (51.6%), and pain on erection (17.9%) in group I, while it was penile curvature (77.1%), erectile dysfunction (54.6%), and pain on erection (14.4%) in group II. In group I, 27 patients (30.3%) were diagnosed during a standard evaluation for erectile dysfunction. Hypertension was significantly higher in group I (25.8%) than in group II (15.4%) (P = 0.022); whereas hypercholesterolemia was more common in group II (P = 0.008). There was no significant correlation between the presence or the number of co-morbid conditions and the presence of the notching deformity. Combined injection and stimulation test revealed a diminished erectile capacity in 46.1% of the patients in group I, while it was 31.7% in group II (P = 0.008). In group I, 62.9% had unilateral notching deformity, 34.8% had hourglass deformity, and 2.2% had combined hourglass and notching deformity. Overall, the notching deformity was localized in the distal penile shaft in 50.5%, proximal shaft in 40.4%, and mid-shaft in 8.9% of the patients in group I. CONCLUSIONS: In this large-scale series, pure notching deformity was detected in about one-tenth of patients with Peyronie's disease. Patients presented at the first half of the sixth decade of life and more than half of the patients were in the acute phase of the disease. The most common presenting symptom was erectile dysfunction. The notching deformity was more frequently localized at the base and tip of the penis.

Are there predictive factors for the outcome of endoscopic treatment of grade III-V vesicoureteral reflux with dextranomer/hyaluronic acid in children?

Dextranomer/hyaluronic acid (Dx/HA) copolymer has been used widely for the treatment of vesicoureteral reflux (VUR) in children since 2001. However, the factors that influence the outcome of injection therapy with Dx/HA have remained unclear. In this study, we retrospectively evaluated the outcomes in 101 consecutive children to determine the cure and to identify the factors that can impact treatment outcomes of Dx/HA injection. Endoscopic treatment with Dx/HA was performed in 133 ureters, in 101 patients with grade III-V VUR. Of the patients, 68 (67.3%) were girls and the mean age was 6.5 years. Before and after the treatment, the presence and grades of VUR were determined by voiding cystourethrograms. The patients' age, gender, laterality, preoperative reflux grade, ureteral duplication, morphology of ureteral orifice, renal hypoplasia and experience with surgery were assessed as predictive factors related to the success rates of Dx/HA injection therapy. The cure rates were 54.8% after the first injection, 66.9% after the second and 73.6% after the third injection. Patients with a high grade (grade IV or V), duplicated system, golf hole-shaped orifice and renal hypoplasia had significantly lower cure rates (P<0.05). Experience with the technique also correlated with the positive outcome of the procedure. New contralateral vesicoureteral reflux developed in five (7.2%) patients with unilateral VUR, and all of them resolved spontaneously during the first year of followup. No treatment-related significant complication was encountered. Although, endoscopic treatment of VUR with Dx/HA provides a high rate of success in children with medium or high grade VUR, treatment failure may be seen in some patients. However, we showed that endoscopic treatment with Dx/HA was effective in selected patients with grade V VUR, and we emphasize the need for further large-scale studies to confirm our findings.