Atilla Ergin

A Novel Treatment Modality in Patients With Premature Ejaculation Resistant to Conventional Methods: The Neuromodulation of Dorsal Penile Nerves by Pulsed Radiofrequency

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of <1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 +/- 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 +/- 17.9 and 139.9 +/- 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 +/- 0.3 and 4.6 +/- 0.5, and mean SSSs of partners before and after treatment were 1.3 +/- 0.4 and 4.4 +/- 0.5, respectively. In all cases, IELT and SSS were significantly increased (P < .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 +/- 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

A Typical Low-Back Pain Caused by an Atypical Etiology

Objective: Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. Case Report: A 54-year-old woman presented with a 2-month history of low-back pain and right-sided sciatica. Conventional analgesics, physiotherapy, and epidural steroid application had failed to provide relief. She had tenderness of the right sacroiliac joint. Diagnostic fluoroscopic-guided sacroiliac-joint injection with lidocaine did not produce symptomatic relief. Pelvic ultrasonography and magnetic resonance imaging showed septated multilocular hydatic cysts along the sciatic nerve. Surgical exploration noted multicystic lesions along the sciatic nerve woven to the nerve. Her low-back pain disappeared completely after the operation. She received oral albendazole for 6 months to prevent any recurrence of the disease and remains asymptomatic. Conclusion: Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.

Accuracy of caudal epidural injection: the importance of real-time imaging.

Abstract:  Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure.

Do the Patients Read the Informed Consent

BACKGROUND Informed consent is a process which consists of informing the patient about the medical interventions planned to be applied to the patients body and making the patient active in the decision making process. AIMS The aim of this study was to evaluate whether the patients read the informed consent document or not and if not, to determine why they did not read it. This was achieved via a questionnaire administered at the pre-anaesthetic visit to assess the perception of patients to the informed consent process. STUDY DESIGN Survey study. METHODS The patients were given a questionnaire after signing the informed consent document at the pre-anaesthetic visit. We studied whether the patients read the informed consent document or not and asked for their reasons if they did not. RESULTS A total of 522 patients were included during the two month study (mean age: 38.1 years; 63.8% male, 36.2% female). Overall, 54.8% of patients reported that they did not read the informed consent. Among them, 50.3% did not care about it because they thought they would have the operation anyway, 13.4% did not have enough time to read it, 11.9% found it difficult to understand, 5.9% could not read because they had no glasses with them, and 5.2% found it frightening and gave up reading. Inpatients, older patients and patients with co-morbidities were less likely to read the informed consent document than outpatients, and younger and healthy patients (p<0.05). Also, 57.9% of parents whose children would be operated on had read the document. CONCLUSION This study shows that the majority of our patients did not understand the importance of the informed consent. It is therefore concluded that informed consent documents should be rearranged to be easily read and should be supported with visual elements such as illustrations or video presentations, as informed consent is a process rather than just simply signing a form.

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

SUMMARY Aim: The aim of this study was to investigate postoperative analgesic effectiveness of intraarticular (IA), intramuscular (IM) or intrathecal (IT) administration of morphine in arthroscopic knee surgery. Materials and Methods: Seventy-six patients with ASA physical status I-II, aged 18 to 65 years, undergoing arthroscopic knee surgery were included in the study. Morphine (10 mg) was given via IA and IM in groups IA (n:21) and IM (n:16), respectively, at the end of the surgical procedure. IT 0.1 mg morphine was administered together with the local anesthetic in Group IT (n:21). Morphine was not applied to 18 control patients (Group C). Visual analogue scale scores for pain were analyzed. Additional analgesic requirement, side effects of morphine and hemodynamic parameters were compared between the groups. Results: None of the patients in Group IT needed additional analgesic treatment in the first 24 hours, whereas 14.3 %, 25.0 % and 72.2 % of the patients needed additional analgesic administration in the groups IA, IM and C, respectively (p<0.001). There was no difference in nausea or vomiting between groups (p=0.07). Fifteen patients in Group IT and 3 patients in Group IA experienced itching. Conclusion: Morphine in three administration routes provides similar analgesic effect and better analgesia in comparison to the control group. Due to the higher incidence of side effects in the IT group, either IA or IM route may be chosen for an adequate postoperative analgesia at the dose used in the present study.