Effects of the dopamine D3 receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin in hyperthyroidism-induced premature ejaculation rat model.

Various factors are involved in the aetiology of premature ejaculation (PE). Hyperthyroidism is one of the causes of acquired PE, but the exact mechanism by which it causes the disorder is not yet understood. The aim of this study was to evaluate the role of the dopaminergic system in hyperthyroidism-induced PE by the intracerebroventricular microinjection of the preferentially active dopamine receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin (7-OH-DPAT) in a rat model of this disorder. Wistar rats were randomly divided into hyperthyroid and control groups, and ejaculation was induced by the ICV administration of 7-OH-DPAT. To evaluate the emission and expulsion phases of ejaculation, measurements of seminal vesicle pressure (SVP) and electromyographic recordings of the bulbospongiosus muscle were taken. The interval between the 7-OH-DPAT administration and the first ejaculation was significantly less in the hyperthyroid group (p < .01) than in the control group, and the maximum amplitude of the SVP values revealed a statistically significant difference between the groups (p < .01). The intervals between contractions of the seminal vesicle and bulbospongiosus muscles were also significantly less in the hyperthyroid group (p = .0187) than in the control group. No other results differed significantly between the groups. This study determined that hyperthyroidism altered only the emission phase of ejaculation.

The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction.

The aim of this study was to investigate the relationship between penile color Doppler sonography (CDS) findings and sonographic endothelial parameters in patients with erectile dysfunction (ED), including intima-media thickness (IMT) of common carotid arteries (CCA) and flow-mediated dilatation (FMD) of brachial artery. Fifty-six ED patients were included in the study. Penile CDS, IMT of CCA and FMD of brachial artery were performed in all patients. According to penile CDS findings, 27 (48%) patients had non-vasculogenic and 29 (52%) patients had vasculogenic ED. Among 29 patients, 17 (30%) patients had cavernous veno-occlusive disease (CVOD) and 12 (22%) patients had arterial/combined insufficiency (AI). Median (interquartile range) FMD values of non-vasculogenic ED, CVOD and AI were 12.50 (6.54)%, 12.82 (7.41)% and 6.25 (7.17)%, respectively. FMD was found to be impaired significantly in AI group when compared to the other groups. FMD values of CVOD group were lower when compared to non-vasculogenic group, but the difference was not statistically significant. IMT values of vasculogenic ED patients were higher than non-vasculogenic ED patients (P<0.05). Although IMT values were higher in AI group when compared to CVOD, the difference was not statistically significant. The combined use of IMT and FMD established the diagnosis of vasculogenic ED with 100% sensitivity and 59.2% specificity. The positive predictive value was 72%, negative predictive value 100% and accuracy 80%. The combined use of brachial artery FMD and carotid arteries IMT measurements may be suggested as an alternative method to evaluate vasculogenic ED.

Sexual dysfunction in male patients on hemodialysis: assessment with the International Index of Erectile Function (IIEF).

In this study we determine the sexual problems and the prevalence of erectile dysfunction (ED) in male hemodialysis patients by means of the International Index of Erectile Function (IIEF). A total of 187 male patients were included in the study. All of the patients who underwent hemodialysis were asked to complete the IIEF questionnaire. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain. Patients were also asked to report whether they had disclosed their sexual problems to physicians or not.The mean age was 49.3+/-13.2 y and the duration of hemodialysis was 38.1+/-8.4 months. By means of the IIEF, the prevalence of erectile dysfunction of any degree was 80.7%. The prevalence of any ED for the patients <50 y and >or=50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients >or=50 y. The frequency of intercourse attempts during the last four weeks was 1-2 in 130 (69.5%) of patients. Only 1% of patients disclosed their erectile problems and sought medical assistance prior to our study.Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increased with age. Evaluations for ED should be included in routine assessment of hemodialysis patients.

Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography.

The aim of this study was to investigate the effects of sildenafil on ocular hemodynamics by color Doppler ultrasonography (CDU). In all, 38 patients with erectile dysfunction diagnosed by International Index of Erectile Function (IIEF) and Sexual Health Inventory of Men (SHIM) scores were included into the study. After taking 100 mg of oral sildenafil citrate, all patients underwent CDU examination of central retinal artery at 60 and 75 min and CDU examination of cavernosal artery at 20, 60 and 75 min. All of the side effects during and after the test were also recorded. The mean cavernous artery peak systolic flow velocity increased significantly after sildenafil. However, no significant change was determined in central retinal artery flow parameters including peak systolic flow velocity, end-diastolic flow velocity, resistive index, pulsatility index, volume and diameter. Five patients experienced ocular side effects. No significant change was observed in retinal artery CDU measurements of patients having ocular side effects. Sildenafil has no effect on ocular hemodynamics on the basis of CDU. Ocular side effects may be the result of other changes in retinal photoreceptors rather than the ocular circulation.

Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys.

Although extracorporeal shockwave lithotripsy (SWL) has dramatically changed the management of urinary tract stone disease, the anatomic abnormalities of horseshoe kidneys cause some difficulties in the use of SWL in this disorder. In this study, 18 patients with stone-bearing horseshoe kidneys were investigated retrospectively in order to determine the effectiveness of SWL. Patients received an average of 11,437 + or - 3062 shocks at an average of 18.8 kV with the Siemens Lithostar. Ten patients were treated in the supine position; stones could be localized in the prone position in eight. Catheterization with a double-J stent was the only adjunctive procedure; it was used in four patients prior to SWL. Adequate stone fragmentation (smaller than 5 mm) was achieved in 14 of the 18 patients (78%). Although 5 of them (28%) became stone free within 6 months after the treatment, residual fragments persisted in 9 patients (50%) during the mean follow-up of 55 months. Stones of 4 patients (22%) were not fragmented adequately. We concluded that although adequate fragmentation can be achieved in stone-bearing horseshoe kidneys, the anatomic abnormalities prevent fragment passage in a substantial number of patients.

Effect of extracorporeal shockwave lithotripsy on plasma and urine endothelin concentrations.

Since the first reports of extracorporeal shockwave lithotripsy (SWL), there have been increasing numbers of articles in the literature documenting renal blood flow impairment and blood pressure elevation as complications. However, little is known about the pathophysiology and prevention of these complications. In this prospective study, the influence of high-energy shockwaves on plasma and urine endothelin concentrations was investigated in 20 patients with renal stones. The patients were randomly assigned to receive a calcium channel blocker, 10 mg of nitrendipine (Bypress; Bayer) (N = 10) 2 hours before SWL or no medication (control group; N = 10). Blood samples were taken just before and 1 minute after application of 3000 shocks. Urine samples were collected by ureteral catheters. The plasma endothelin-1 concentrations were significantly elevated after SWL in the control group (P = 0.003). On the other hand, nitrendipine significantly reduced plasma endothelin concentrations after SWL (P = 0.003). No significant change was observed in urine samples and blood pressure measurements. These results suggest that endothelin release after SWL may be a cause for lithotripsy-induced hemodynamic changes. Medical prevention with calcium channel blockers warrants further investigation.

Are obstructing ureteral stones more difficult to treat with extracorporeal electromagnetic shock wave lithotripsy?

In situ extracorporeal shock wave lithotripsy (ESL) has increasingly become accepted for the treatment of ureteral stones. However, treatment success is negatively affected by stone impaction or associated urinary obstruction. In order to assess the impact of obstruction on the outcome of in situ ESL, we reviewed the results in 503 patients treated in this way. The presence and severity of urinary obstruction was defined prior to ESL, being classified as no or mild obstruction (Group I) and moderate or severe obstruction (Group II). The stone-free rate in the nonobstructed group was 90%, whereas it was 85% in the obstructed group (P > 0.005). While all of our patients were treated on an outpatient basis, two patients in Group I and four patients in Group II required hospitalization with the diagnosis of pyelonephritis. All six patients were treated successfully with appropriate measures. No other serious complication occurred that required hospitalization. We conclude that urinary obstruction does not affect stone disintegration or passage and suggest that in situ ESL should be the treatment of choice in ureteral stones.

Does respiratory gating improve extracorporeal shockwave lithotripsy results?

The reliability and efficacy of extracorporeal shockwave lithotripsy (SWL) has been established in urinary stone disease. Its combination with respiratory gating might be a useful method to increase the effectiveness of treatment and reduce the number of shocks required. For this purpose, the results of SWL combined with respiratory gating were compared with those of SWL without gating. There was no difference in the stone-free rates of the two groups or in the complication rate. It is concluded that this method neither decreases the number of shockwaves needed nor increases the effectiveness of SWL.

Open stone surgery: is it still a preferable procedure in the management of staghorn calculi?

We reviewed 43 patients with staghorn calculi to determine the effectiveness of various treatment modalities such as extracorporeal shock wave lithotripsy (ESWL) monotherapy, ESWL and percutaneous nephrolithotomy (PCNL) combined therapy, and open stone surgery. While ESWL monotherapy and ESWL+PCNL were performed in 25 and 8 patients, respectively, 10 patients underwent open stone surgery. Of the 25 patients treated with ESWL, 8 were stone-free, whereas 4 out of 8 patients treated with ESWL+PCNL and 8 out of 10 patients treated with open surgery were stone-free. The complications of ESWL monotherapy consisted of pyelonephritis in one patient, and stone street formation in three. In the group of ESWL+PCNL, one patient developed pyonephrosis, and another perinephritic abscess. No serious complication was noted in patients who underwent open surgery, but an average of 525 ml of blood transfusion was required. We conclude that open stone surgery, although invasive, is still beneficial in the treatment of staghorn calculi.

Magnetic resonance imaging in the staging of renal cell carcinoma.

Correct diagnosis and accurate staging of renal cell carcinoma are critical in the evaluation of prognosis and subsequent treatment planning. Between October 1989 and April 1993, 25 patients with histologically proven renal cell carcinoma (RCC) were studied, comparing magnetic resonance imaging (MRI), computerized tomography (CT), operative findings and histopathological results. Two patients with pT3 tumours were understaged by both methods as T2. Three other patients staged as T4 by CT and T3 by MRI were actually pT3. N and V status were accurately detected by both imaging modalities. One patient with biopsy-proven liver metastasis missed by CT was correctly diagnosed by MRI. We conclude that MRI is complementary to CT and is especially helpful in patients with advanced stage and large sized tumours.

Place of double-J stents in extracorporeal shock wave lithotripsy.

Although double-J stents (DJS) are used to reduce complications following extracorporeal shock wave lithotripsy (ESWL), there has recently been a tendency to limit their use because of complications. We retrospectively reviewed 351 patients with renal stones larger than 30 mm to determine the effectiveness and the complications of DJS. While DJS were inserted prior to ESWL in 85 patients, 266 patients were treated without. The stone-free rate in the stented group was not significantly different from the non-stented group (31 and 30%). While the auxiliary treatment rate for the steinstrasse was 15% in the stented group, it was 18% in the non-stented group. Additionally, 4 of the stented patients (5%) were treated endoscopically because of encrustation or migration of the stent. Half of the patients in the stented group complained of mild bladder discomfort and disturbances which were relieved after removal of the DJS. We believe that DJS neither enhance stone passage nor reduce complications following ESWL, and therefore suggest their use only under certain conditions such as patients with solitary kidneys.

Ferritin: a tumor marker expressed by renal cell carcinoma.

Renal cell carcinoma (RCC) has been shown to secrete several hormones and biologically active substances that influence the host metabolism or induce paraneoplastic syndromes. Observation of anemia in 20% of patients with RCC and the spontaneous recovery of anemia following nephrectomy drew attention to the body iron metabolism. Ferritin was previously proposed as a tumor marker for RCC. In order to determine whether RCC cells actually produce ferritin, we studied ferritin levels in serum from peripheral and renal veins as well as from the tumor tissue and the healthy parenchyma from radical nephrectomy specimens of 22 patients with RCC. Ferritin levels both in sera and cytosols were measured by an enzyme immunoassay method. The mean serum ferritin level from the renal vein was 419.9 +/- 72.4 ng/ml, and it was 157.3 +/- 18.3 ng/ml from the peripheral vein (p < 0.05). Renal vein ferritin correlated with stage and had a significant impact on prognosis (p < 0.05). The mean cytosolic ferritin level of the cancer tissue was 705.6 +/- 56.9 ng/mg cytosol protein, whereas in the normal parenchyma it was 95.9 +/- 10.1 ng/mg cytosol protein. This was also highly significant (p = 1.15 x 10(-13)), suggesting that RCC cells probably express ferritin. As currently there exists no reliable tumor marker for RCC, the value of ferritin as a marker should be investigated further before drawing any clinical conclusions.

Contractility changes of the deep dorsal penile vein due to serotonin.

PURPOSE: Penile erection is a complex neurovascular phenomenon that takes place with the active contribution of arterial and sinusoidal structures. However, some authors claim that larger veins including the deep dorsal veins that produce contractions, might be involved in the physiology of erection. This study was designed to clarify the contractile properties of deep dorsal penile veins (DDPV). MATERIALS AND METHODS: The effect of serotonin (5-HT), noradrenaline (NA), adenosine triphosphate (ATP) and acethylcholine (Ach) on the isolated DDPVs of 16 impotent men, 9 with veno-occlusive dysfunction and 7 without venous leakage, and 5 potent men (controls) who underwent radical prostatectomy, were examined in vitro. RESULTS: Although NA, ATP and Ach had no effect, 5-HT produced concentration-dependent contractions. Emax and pEC50 of 5-HT were 411 +/- 10 mg., 5.92 +/- 0.25; 1020 +/- 260 mg., 5.83 +/- 0.24 and 160 +/- 40 mg., 6.4 +/- 0.22 in controls and patients who had venous leakage and no venous leakage, respectively. Samples of controls were contracted only with 5-HT2 agonist, DOI (pEC50 = 5.63 +/- 0.02), and these contractions were antagonized with 5-HT2 antagonist ketanserin. On the other hand, both DOI (pEC50 = 6.30 +/- 0.77) and 5-HT1 agonist, 5-CT (pEC50 = 6.23 +/- 0.21) produced venoconstriction in patients with veno-occlusive dysfunction. CONCLUSIONS: The present findings suggest that 5-HT receptor functions in the DDPVs are of 5-HT2 subtype in potent men and the altered response to 5-HT in patients with veno-occlusive disease may play a role in the pathophysiology of impotence.

The prediction of papaverine induced priapism by color Doppler sonography.

PURPOSE: We identified color Doppler sonography findings that are useful for predicting priapism in patients after the intracavernous injection of diagnostic papaverine. MATERIALS AND METHODS: We evaluated 72 men with erectile dysfunction by color Doppler sonography after the diagnostic injection of papaverine. Cavernous artery waveforms were recorded, and peak systolic and diastolic velocity of the recorded waveforms was measured. In cases of priapism color Doppler sonography findings were retrospectively evaluated to identify any finding that would predict priapism. RESULTS: Priapism was observed in 8 of the 72 patients (11.1%). In 6 of 8 priapism cases there was no blood flow in the cavernous artery during or after adequate erection, including after minutes 5, 10 and 20 in 3, 1 and 2, respectively. This absence of encoding was not relieved even after all stimuli were removed. In 2 patients who later presented with complaints of priapism the Doppler study was completed normally and all parameters were acquired without any cessation of blood flow in the cavernous artery. The persistent disappearance of color and pulse encoding in the cavernous artery predicted priapism with 75% sensitivity, 100% specificity, a positive and negative predictive value of 100% and 96.9%, respectively, and 97% accuracy. CONCLUSIONS: The persistence of absent blood flow in the cavernous artery even after the elimination of all stimuli during penile color Doppler ultrasound is a reliable predictor of priapism. The finding is accurate enough to initiate treatment for priapism to avoid further delay.

Concealed penis: rare complication of circumcision.

A man presented with a concealed penis which developed after circumcision. In addition to anatomic variations in penile skin attachment and obesity, circumcision is an iatrogenic cause in the etiology of a concealed penis. Although it is a frequent and simple operation, it may lead to uncommon complications due to a lack of experience and poor technique.

A new method for the evaluation of erectile dysfunction: sildenafil plus Doppler ultrasonography.

PURPOSE: Of the various methods of hemodynamic studies performed to evaluate erectile dysfunction penile color Doppler ultrasound is currently considered the best. However, intracavernous injection is invasive and has adverse effects, such as prolonged erection. We evaluated whether sildenafil may be used as a substitute for intracavernous agents when assessing impotence on color Doppler ultrasound. MATERIALS AND METHODS: A total of 42 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg. papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 minutes after injection. The patients also underwent color Doppler ultrasound after a 50 mg. oral dose of sildenafil with genital and audiovisual sexual stimulation not before 3 days after the papaverine study. The same parameters were measured at 30, 45, 60, 75 and 90 minutes, and compared with the values obtained after papaverine injection. RESULTS: Mean peak flow velocity significantly increased after oral sildenafil starting at 30 minutes and achieving a maximum value at 60 minutes. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 minutes after papaverine injection, and 30, 45, 60, 75 and 90 minutes after oral sildenafil administration. Penile color Doppler ultrasound with intracavernous papaverine injection is accepted as the gold standard but color Doppler ultrasound with sildenafil has 90% sensitivity and 100% selectivity for demonstrating arterial insufficiency. Due to prolonged erection 5 patients (11.9%) in the papaverine group required pharmacological detumescence by intracavernous injection. No adverse effects of sildenafil were observed. CONCLUSIONS: Sildenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection sildenafil emerges as a safer alternative compared to more invasive intracavernous injection.

Recovery period of the bladder after exposure to soluble virulence factor produced by Escherichia coli.

OBJECTIVES: This study was designed to determine the time interval required for the recovery of the bladder after exposure to soluble virulence factor (SVF) in an animal model. In addition, we aimed to determine the changes in the epithelium during the recovery period. METHODS: A total of 46 male New Zealand rabbits were used in this study. Sterile human urine was infected with Escherichia coli type O6 to obtain supernatant, which would contain SVF, but no bacteria. Rabbits were assigned to one of three groups comprising the supernatant urine group (SUG) and controls, respectively. Sterile human urine and supernatant urine were instilled to controls and SUG, respectively. Bacterial inoculation with E. coli was performed 1, 24 and 72 h after initial instillation. Histopathologic and microbiologic analyses were performed on these animals. RESULTS: In SUG bacterial colonization was significantly higher than in controls 1 and 24 h after exposure to supernatant. Histopathologic analysis confirmed this finding. Histologic changes were most pronounced 1 hour after instillation of supernatant. A moderate degree of recovery was noted at 24 h, and complete recovery was seen at 72 h. CONCLUSION: Bacterial growth is potentiated by SVF-induced impaired bladder mucosa until the repairing process has been completed. During this time interval, SVF enables the colonization and growth of E. coli and other bacterium species that may result in sustained bacterial presence and recurrent infection.

The effect of extracorporeal electromagnetic shock waves on the morphology and contractility of rabbit ureter.

PURPOSE: Although extracorporeal shock wave lithotripsy (ESWL) is known to cause pathologic changes in various organs, little is known about its effects on the ureter, the target organ in ESWL of ureteral stones in situ. In this study, we sought to determine the short-term effects of ESWL on the ureter. MATERIALS AND METHODS: Left lower ureteral segments of 21 rabbits were removed to serve as the control group and 2000 shocks were applied to the right lower ureters. Groups of 7 rabbits were sacrificed 1, 3 and 5 days after shock wave exposure. While histomorphological alterations were examined under light and transmission electron microscopy, contractility of all ureters was determined in organ baths. RESULTS: The epithelial cells disclosed no change after shock wave application. Histologically the muscular layer was the most affected part of the ureter. There was interstitial and intracellular edema on light microscopy and marked chromatin and mitochondrial changes at the subcellular level. The adventitial layer was also edematous. These changes were prominent on days 1 and 3 and returned to normal on day 5. The contractility of the ureters on day 1 was significantly reduced (p < 0.05). However, the contractility of the samples on days 3 and 5 were not significantly different from controls. CONCLUSION: Our findings demonstrate that electromagnetic shock waves produce reversible morphological and functional changes in rabbit ureteric muscle.

Efficacy and safety of sildenafil for treating erectile dysfunction in patients on dialysis.

OBJECTIVE: To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end-stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis). PATIENTS AND METHODS: Forty-one patients with ED and in ESRD participated in an open-label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl-Meyer life-satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of < or = 25 was accepted as indicating ED. All patients were started on a 25-mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side-effects during treatment. RESULTS: The erectile function and intercourse satisfaction domains improved significantly in both groups (P < 0.01). After sildenafil treatment, two-thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (P < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side-effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often. CONCLUSIONS: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.