Adil Esen

Sexual function in women with urinary incontinence

To date limited data exists that addresses the impact of urinary incontinence on sexual function. In the present study, we assessed sexual functions in patients with urinary incontinence and compared with healthy continent subjects by means of Female Sexual Function Index (FSFI) questionnaire. A total of 21 premenopausal incontinent women (three stress incontinence, nine overactive bladder and nine mixed incontinence) were enrolled in the study, and 18 healthy continent subjects served as controls. All subjects were asked to complete FSFI questionnaire and each FSFI domain scores including desire, arousal, lubrication, orgasm, satisfaction and pain were calculated. The mean scores in each domain were compared between the groups. Mean age of subjects with urinary incontinence and controls were 39.5±6.6 and 32.6±9.1 y, respectively. All domain scores were significantly lower in incontinent women except for pain. Among the incontinence types, no significant difference was determined in all domains of FSFI. Urinary incontinence significantly reduces sexual functions in premenopausal sexually active women.

A prospective analysis of sexual functions during pregnancy

The aim of the study was to evaluate the sexual functions during pregnancy using the Female Sexual Function Index (FSFI) questionnaire. Pregnancies were recorded in a prospective cohort study comprising 40 healthy pregnant women. Pregnant women who had a stable relationship with their partner were enrolled in the study when were first diagnosed to be pregnant. During their antenatal visits, subjects were asked to complete the FSFI questionnaire and other information about their sexual life in each trimester. Each FSFI domain score was calculated and mean scores in each domain were compared according to the trimesters of pregnancy. Data of 37 subjects for the first, 36 for the second and 34 for the third trimesters of pregnancy were eligible for the analysis. The mean age was 25.5±4.5 y; mean parity was 0.4±0.7 and mean gravity was 1.6±0.9. The frequency of intercourse attempts during the last 4 weeks was 8.6±3 before pregnancy, and 6.9±2.5, 5.4±2.6 and 2.5±1.4 in the first, second and third trimesters of pregnancy, respectively. In all domains of FSFI, significant decline in domain scores was determined during pregnancy. The comparison of satisfaction and pain domain scores between first and second trimesters showed significant differences. All of the domain scores significantly decreased in the third trimester of pregnancy. Our results showed that sexual functions are significantly decreased during pregnancy and worsen as the pregnancy progresses. Childbearing couples should be given information about the sexual problems and fluctuations in the patterns of sexuality during pregnancy.

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 ≥50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients ≥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.

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).

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 formations 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.

Serum ferritin: a tumor marker for renal cell carcinoma.

Serum ferritin levels in 32 patients with renal cell carcinoma were evaluated preoperatively and postoperatively. Serum ferritin concentration was significantly higher in renal cell carcinoma patients compared to controls (259.10 versus 61.30 ng./ml., p less than 0.001). Furthermore, there was a steady and statistically significant increase in serum ferritin levels with advancing disease stage, as well as a significant decrease in serum ferritin levels after nephrectomy for stages 1 and 2 disease. The intracellular content of ferritin as estimated by polyclonal antibody was dramatically increased in renal cancer tissue compared to normal parenchyma. Although serum ferritin regulation is complex and only partly understood, the present study suggests that serum ferritin may be a useful tumor marker for renal cell carcinoma.

ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND ERECTILE DYSFUNCTION

Our aim was to assess the association between lower urinary tract symptoms (LUTS) and erectile dysfunction by means of International Prostate Symptom Score (IPSS) and Sexual Health Inventory for Men (SHIM) questionnaire. A total of 69 eligible patients who were admitted to our outpatient clinic with lower urinary tract symptoms were included in the study. A self administered questionnaire of IPSS and SHIM were given to patients. Demographics and medical history data were recorded. Any risk factor that may be associated with erectile dysfunction, including coronary artery disease, diabetes, hypertension, and smoking status, was determined in each patient. Correlation tests were used to examine the relationship between lower urinary tract symptoms and erectile dysfunction by controlling the effects of age and comorbidities. Mean age was 58.6 ± 13.1 31–86 years. Mean SHIM and IPSS total score was 14.3 ± 7.5 and 11.5 ± 8.1, respectively. Spearman correlation coefficient between IPSS and SHIM scores was found to be −0.41. There was a significant negative correlation with IPSS total scores of moderate degree when both age and presence of risk factor was controlled (r = −0.31; p = 0.009). Storage symptom scores showed significant correlation with SHIM scores (r = −0.33; p = 0.000). The association between SHIM score and each item of IPSS showed significant correlation for urgency, straining and nocturia when age controlled. The degree of bother by LUTS as determined by the IPSS quality of life question was also correlated with SHIM scores; however, this correlation was not significant when age or risk factor for ED was controlled. The presence of LUTS especially storage symptoms is strongly associated with erectile dysfunction independent of age and comorbidities.

Assessment of sexual functions in patients with chronic liver disease

We aimed to determine the sexual problems and the prevalence of erectile dysfunction (ED) in patients with chronic liver disease by means of International Index of Erectile Function (IIEF). A total of 81 patients with stable chronic liver disease were included in the study. Patients were grouped as mild to moderate (Child Pugh A and B) (n=10), chronic hepatitis (hepatitis B, C and D) (n=28) and carriers (n=43) according to the type of their chronic liver disease. All patients were asked to complete a questionnaire including IIEF and demographics. The IIEF domain scores were calculated and ED grading was determined on erectile function domain. IIEF domain scores were compared between these groups. The mean age was 54.8 ± 10.8 y. Using the IIEF, the prevalence of any ED was 50.6% for all patients, and 50, 50, and 51.1% for cirrhosis, chronic hepatitis and carriers, respectively. The IIEF domain scores were not significantly different among the patient groups. Sexual functions did not appear to be affected by the stable chronic liver disease.

Relation between acute urinary retention, chronic prostatic inflammation and accompanying elevated prostate-specific antigen

Objective. To determine if there is a relationship between acute urinary retention (AUR), the prostate-specific antigen (PSA) level and chronic inflammation of the prostate. We therefore studied patients with benign prostatic obstruction (BPO) with (n=64) or without (n=168) acute urinary retention (AUR) who underwent transurethral resection of the prostate (TURP) in a retrospective case control study. Material and methods. Between 2001 and 2004, a total of 232 patients underwent TURP due to BPO with or without AUR. The mean values of age, prostate volume, weight of resected prostate and PSA level and the histopathologic results of patients with and without AUR were compared. χ2 analysis was used to examine the relationship between prostatic inflammation and AUR. The contribution of each variable to AUR was assessed by means of multiple linear regression. Results. A total of 64 patients (28%) were operated on for AUR due to BPO. There were no statistical differences between patients with or without AUR with respect to the mean values of PSA, percent free PSA, prostate size or weight of the resected prostate tissue. Elevated PSA values (≥4.0 ng/ml) were detected in 64% and 38% of the patients in the AUR and non-AUR groups, respectively (p=0.01). Histopathological re-evaluation demonstrated that chronic prostatic inflammation was present in 56% and 37% of the specimens in the AUR and non-AUR groups, respectively (p=0.014). In the AUR group, the mean PSA level was significantly higher in patients with than without prostatic inflammation (7.75±5.26 vs 5.07±3.21 ng/ml; p=0.022). The odds ratio of AUR for patients with chronic prostatic inflammation and elevated PSA was determined as 4.14 (95% CI 1.65–10.41). Multiple linear regression revealed that prostatic inflammation made a significant contribution to AUR. Conclusions. Chronic prostatic inflammation may be histopathological evidence of both elevated PSA level and AUR; hence it may play a role in the pathophysiology of AUR.

Sexual Function in Men with Lower Urinary Tract Symptoms and Prostatic Enlargement Secondary to Benign Prostatic Hyperplasia: Results of a 6‐Month, Randomized, Double‐Blind, Placebo‐Controlled Study of Tadalafil Coadministered with Finasteride

INTRODUCTION Tadalafil (TAD) 5 mg coadministered with finasteride (FIN) 5 mg significantly improves lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) and prostatic enlargement. However, its effects on erectile/sexual function have yet to be fully described. AIM Assess the effects of TAD/FIN coadministration (compared with placebo [PBO]/FIN) on erectile and sexual function in sexually active men with LUTS and prostatic enlargement secondary to BPH with or without baseline comorbid erectile dysfunction (ED). METHODS A randomized, double-blind, PBO-controlled study of 695 men (610 sexually active; 450 with baseline ED; 404 sexually active with baseline ED) conducted at 70 sites in 13 countries. TAD 5 mg or PBO once daily coadministered with FIN 5 mg once daily for 26 weeks. MAIN OUTCOME MEASURES International Index of Erectile Function (IIEF) domain and single-item scores; proportions of patients who demonstrated minimal clinically important differences (MCIDs) in IIEF-Erectile Function domain scores (IIEF-EF; MCID defined as ≥4-point improvement); and sexual dysfunction adverse events (AEs). RESULTS Compared with PBO/FIN, TAD/FIN resulted in improvements for all IIEF domain and single-item scores assessed among patients with baseline ED (P ≤ 0.002 for all measures) and among patients without baseline ED (P ≤ 0.041 for all measures). Compared with PBO/FIN, significantly larger percentages of sexually active men with baseline ED treated with TAD/FIN achieved an IIEF-EF MCID after 4, 12, and 26 weeks of therapy (P < 0.001 for odds ratio comparisons between TAD/FIN and PBO/FIN at all 3 three postbaseline timepoints). The incidence of sexual AEs was low: five TAD/FIN patients and seven PBO/FIN patients reported sexual AEs, including ED, decreased/lost libido, and ejaculation disorders. CONCLUSIONS TAD/FIN coadministration for the treatment of men with LUTS and prostatic enlargement secondary to BPH concurrently leads to statistically significant improvements in erectile/sexual function and is well-tolerated, regardless of the presence/absence of ED at treatment initiation.