Ahmet Cihan

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.

The Relationship Between Premature Ejaculation and Hyperthyroidism

PURPOSE We determine the prevalence of premature ejaculation in patients with hyperthyroidism and observed intravaginal ejaculation latency time alterations before and after hyperthyroidism treatment. MATERIALS AND METHODS Between January 2004 and June 2007, 49 patients with hyperthyroidism and no history of hyperthyroidism treatment were enrolled in the study. After obtaining a detailed sexual anamnesis an erectile function questionnaire was completed and a patient self-reported outcome measure of difficult control over ejaculation was examined. We assessed stopwatch measurements of intravaginal ejaculation latency time performed by the patient or partner. Patient anxiety status was also evaluated. Changes in the mentioned measurements induced by hyperthyroidism treatment were examined 8 weeks after the achievement of euthyroidism. RESULTS In the 43 eligible patients mean +/- SD age was 48.0 +/- 8.8 years. Premature ejaculation was observed in 31 of the 43 patients (72.1%). Mean intravaginal ejaculation latency time in patients with hyperthyroidism was 72.8 +/- 83.3 seconds. Of the 43 patients 30 (69.8%) were considered to have definite premature ejaculation according to stopwatch measurements. In patients with hyperthyroidism who had definite premature ejaculation anxiety scores were determined to be higher. A positive correlation was noted between serum thyroid stimulating hormone and intravaginal ejaculation latency time in the patients. In 24 patients who completed the followup visits we noted statistically significant improvement in intravaginal ejaculation latency time after the achievement of euthyroidism. CONCLUSIONS Excess thyroid hormone and premature ejaculation are clinically interrelated conditions. Hyperthyroidism should be considered a novel and reversible etiological risk factor for premature ejaculation.

Investigation of the Neural Target Level of Hyperthyroidism in Premature Ejaculation in a Rat Model of Pharmacologically Induced Ejaculation

INTRODUCTION Association between hyperthyroidism and premature ejaculation was demonstrated in clinical studies. AIM The aim of this study is to determine the target level of changes on ejaculatory physiology under hyperthyroid states. METHODS p-Chloroamphetamine (PCA)-induced pharmacologic ejaculation model with 24 male Wistar rats was used in the study. Subcutaneous injection of L-thyroxine for 14 days was performed to induce hyperthyroidism. At the end of the injection period, thyroid hormone status was evaluated by serum thyroid-stimulating hormone measurements in all rats. At the beginning of the operations, complete spinal transections (tx) at the T8-T9 level were performed to half of the L-thyroxine-injected and control group rats. Thus, experimental groups were constructed as follows: Group 1--control-spinal intact (n=6), group 2-control-spinal tx (n=6), group 3-hyperthyroid-spinal intact (n=6), and group 4-hyperthyroid-spinal tx (n=6). Ejaculatory responses were recorded before and 30 minutes after intraperitoneal administration of 5 mg/kg PCA. MAIN OUTCOME MEASURES During the operations, seminal vesicle (SV) catheterization and bulbospongiosus (BS) muscle dissections were performed in all rats to demonstrate SV pressure (SVP) BS electromyographic (EMG) activity changes. RESULTS Following PCA administration SVP tonic amplitude, SV phasic contraction (SVPC) frequency, SVPC maximal amplitude, and BS EMG area under curve values were higher in hyperthyroid intact rats than in control intact rats. The time interval between PCA administration and first ejaculation of hyperthyroid intact rats were significantly shorter than control intact rats (261 ± 7.30 seconds vs. 426 ± 49.6 seconds, P=0.008). All of the changes in the ejaculatory parameters that were induced by hyperthyroidism were completely resolved after spinal transections at the T8-T9 level in group 4. CONCLUSION In this study, we confirmed the recent data that hyperthyroidism affects both the emission and expulsion phases of ejaculation. The changes that were induced by hyperthyroidism on ejaculatory physiology probably take place in the supraspinal centers above T8 level.

An Experimental Approach to the Interrelationship Between Hyperthyroidism and Ejaculation Latency Time in Male Rats

PURPOSE We investigated the effects of experimentally induced hyperthyroidism on seminal vesicle pressure measurements and bulbospongiosus muscle contractile activity in a para-chloroamphetamine (Sigma-Aldrich) induced ejaculation model in rats. MATERIALS AND METHODS Male Wistar rats were used in the study. Daily injection of 25 microg/100 gm body weight L-thyroxine (T4, Sigma-Aldrich) for 14 days was performed in 14 rats to induce hyperthyroidism. Seven L-thyroxine injected rats were in the hyperthyroid group. The remaining 7 rats (recovery group) underwent operation after a 28-day washout period to determine spontaneous recovery from hyperthyroidism. At each operation seminal vesicle catheterization was done to measure intraluminal pressure and bulbospongiosus muscle dissection was performed for electromyography. After intraperitoneal administration of 5 mg/kg para-chloroamphetamine physiological parameters related to the ejaculatory process were measured. RESULTS The interval between para-chloroamphetamine administration and first ejaculation was significantly decreased in the hyperthyroid rat group compared with that in the control group (mean +/- SD 202.8 +/- 22.3 vs 465.4 +/- 104.6 seconds, p = 0.001). Seminal vesicle phasic contraction frequency was significantly higher than control group values in hyperthyroid rats (for 30 minutes 32.3 +/- 13.9, p = 0.047). The mean AUC of bulbospongiosus muscle electromyography activity was also significantly increased in this group (11.1 +/- 4.1 V per second x 10(-4), p = 0.0001). All parameters in recovery and control group rats were not significantly differed from each other. CONCLUSIONS Hyperthyroidism leads to enhanced seminal vesicle contraction frequency and bulbospongiosus muscle contractile activity in rats. Hyperthyroidism affects the emission and expulsion phases of ejaculation in reversible fashion.

Congenital Seminal Vesicle Cyst Accompanying Ipsilateral Renal Agenesis and Rudimentary Ureter

Congenital seminal vesicle cysts are usually diagnosed as incidental sonographic findings in patients with voiding complaints. Rarely they could also be detected in asymptomatic cases. In our study, a seminal vesicle cyst associated with ipsilateral renal agenesis and ureteral bud remnant in an asymptomatic patient is presented.

The giant calculus within the prostatic urethra

The giant calculus within the prostatic urethra is a rare clinical entity in the young population. Most of the calculi within the urethra migrate from the urinary bladder and obliterate the urethra. These stones are often composed of calcium phosphate or calcium oxalate. The decision of treatment strategy is affected by the size, shape and position of the calculus and by the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most cases, the giant calculi were extracted via the transvesical approach and external urethrotomy. Our case is the biggest prostatic calculus, known in the literature so far, which was treated endoscopically by the combination of laser and the pneumatic lithotriptor.

Urethral injury as a complication of isolated diastasis pubis: case report

Diastasis of the symphysis pubis is typically associated with straddle-type pelvic trauma. A case of diastasis pubis due to a recreational water-ski accident is described here. This case is complicated with a partial urethral rupture.

IN VIVO PATHWAY ANALYSIS FOR THE EFFECT OF HYPERTHYROIDISM ON EJACULATION IN PHARMACOLOGICALLY-INDUCED EJACULATION IN ANAESTHETISED MALE RATS

INTRODUCTION AND OBJECTIVE: The aim of the current study is to determine the possible effects of hyperthyroidism on ejaculatory pathways in p-Chloroamphethamine(PCA) induced ejaculation in anaesthetised male rats. METHODS: Sixty male Wistar rats (300-350gr) were used in this study. Subcutaneous injection of L-Thyroxine for 14 days was performed to induce hyperthyroidism in thirty rats. Thyroid hormone status were evaluated by serum TSH measurements in all rats. Under intraperitoneally(i.p.) urethane anaesthesia; euthyroid and hyperthyroid rats underwent bilateral hipogastric nerve(HNx,n=6 for both groups), bilateral pelvic nerve(PNx,n=6 for both groups), bilateral paravertebral sympathetic chain (PSCx,n=6 for both groups) transections, complete spinal transection at the T8-T9 level (n=6 for both groups ) and no peripheral transection (Nonx) was performed for 6 rats in each group. After performing seminal vesicle (SV) catheterization and bulbospongiosus (BS) muscle dissection for SV pressure measuring and BS electromyographic (EMG) recordings we induced ejaculation with i.p. administration of 5 mg/kg PCA. Ejaculatory responses were recorded before and 30 min after PCA administration. RESULTS: After PCA administration SV pressure tonic amplitude, SV phasic contraction(SVPC) frequency, SVPC maximal amplitude and BS EMG area under curve values were higher in hyperthyroid Nonx rats than euthyroid Nonx rats. The time interval between PCA administration and first ejaculation, the time interval between first SVPC and first BS contraction of hyperthyroid Nonx rats were significantly shorter than euthyroid Nonx rats. In hyperthyroid rats bilateral HNx and bilateral PSCx significantly reduced SV tonic pressure ampitude, SVPC frequency and SVPC maximal amplitude. There were no differences in SVPC frequency and SVPC maximal amplitude values for HNx and PSCx between euthyroid and hyperthyroid rats. These values were higher in hyperthyroid PNx rats than euthyroid PNx rats. There were no significant differences between all parameters of emission and expulsion phases of ejaculation for euthyroid and hyperthyroid spinally transected rats. CONCLUSIONS: In this study we confirmed the recent data that hyperthyroidism effects both the emission and expulsion phases of ejaculation. The effect of hyperthyroidism on emission phase is probably by sympathetic pathways. However the overall effect of hyperthyroidism on ejaculation may take place in the central nervous system above T8 level