Ayhan Karabulut

Acupuncture Versus Paroxetine for the Treatment of Premature Ejaculation: A Randomized, Placebo-Controlled Clinical Trial

BACKGROUND Acupuncture therapy has been used by many researchers in both male and female sexual dysfunction studies. OBJECTIVE To determine whether acupuncture is effective as a premature ejaculation (PE) treatment compared with paroxetine and placebo. DESIGN, SETTING, AND PARTICIPANTS The study was conducted with methodologic rigor based on Consolidated Standards of Reporting Trials (CONSORT) criteria. Ninety patients referred to the urology clinic at a tertiary training and research hospital with PE were included in this randomized controlled trial and randomly assigned into paroxetine, acupuncture, and placebo groups. Heterosexual, sexually active men aged between 28 and 50 yr were included. Men with other sexual disorders, including erectile dysfunction; with chronic psychiatric or systemic diseases; with alcohol or substance abuse; or who used any medications were excluded. INTERVENTION The medicated group received paroxetine 20 mg/d; the acupuncture or sham-acupuncture (placebo) groups were treated twice a week for 4 wk. MEASUREMENTS Intravaginal ejaculation latency times (IELTs) and the Premature Ejaculation Diagnostic Tool (PEDT) were used to assess PE. IELTs were calculated by using a partner-held stopwatch. Data were analyzed statistically. RESULTS AND LIMITATIONS Median PEDT scores of paroxetine, acupuncture, and placebo groups were 17.0, 16.0, and 15.5 before treatment, and 10.5, 11.0, and 16.0 after treatment, respectively (p=0.001, p=0.001, and p=0.314, respectively). Subscores after treatment were significantly lower than subscores before treatment in the paroxetine and acupuncture groups but remained the same in the placebo group. Significant differences were found between mean-rank IELTs of the paroxetine and placebo groups (p=0.001) and the acupuncture and placebo groups (p=0.001) after treatment. Increases of IELTs with paroxetine, acupuncture, and placebo acupuncture were 82.7, 65.7, and 33.1 s, respectively. Extent of ejaculation delay induced by paroxetine was significantly higher than that of acupuncture (p=0.001). The most important limitation of the study was the lack of follow-up. CONCLUSIONS Although less effective than daily paroxetine, acupuncture had a significant stronger ejaculation-delaying effect than placebo.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

A huge unusual mass on the penile skin: Acrochordon

Acrochordons are flesh-coloured pedunculated lesions which occur in areas of skin folds. Although they are common in other sites of the body, we report the first case of huge penile acrochordon in the literature. Clinical, pathological and surgical findings of this lesion were presented and discussed.

Single-institution Outcomes of Open Reconstruction Techniques for Management of Pediatric and Adolescent Post-traumatic Urethral Strictures

OBJECTIVES To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. METHODS A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. RESULTS The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. CONCLUSIONS The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

A rare cause of cystic testicular mass in an infant--cystic dysplasia of the testis.

In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.

Our 21-Year Experience with the Thiersch-Duplay Technique following Surgical Correction of Penoscrotal Transposition

Objectives: To assess surgical techniques applied after surgical correction of penoscrotal transposition and their complications. Methods: The medical records of 64 patients with a mean age of 4.1 years (range 1–24) who underwent surgical correction for penoscrotal transposition and subsequent Thiersch-Duplay urethroplasty in the last 21 years were evaluated retrospectively. Results: All cases underwent Thiersch-Duplay urethroplasty following reconstruction of penoscrotal transposition after a minimum interval of 6 months. Following Thiersch urethroplasty, 41 (64%) cases with successful outcomes had glandular meatuses. Of the remaining 23 (36%) patients 15, 7 and 1 patients underwent second operations for urethrocutaneous fistulas, meatal regressions and urethral diverticulum, respectively. Eleven of 15 patients underwent primary fistula repair and 4 patients, turnover fistula repair. These patients had glandular meatuses following fistula repair. Seven cases with meatal regression and breakdown of the neourethra were reoperated on by using double-face urethroplasty, onlay island flap urethroplasty and free-tube urethroplasty techniques. Finally, all patients had glandular meatuses. One patient with urethral diverticulum underwent successful diverticulum excision and meatoplasty. Conclusions: Thierch uretroplasty is the most commonly performed technique after surgical correction of penoscrotal transposition; however, additional procedures are needed for the management of its complications.

Vesicouterine fistula, a rare cause of genitourinary fistula

Uterovesical fistulas are rare genitourinary fistulas developing secondary to iatrogenic etiologies. In this article, we report a a post-cesarean vesicouteri fistula with review of the literature.

Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs

OBJECTIVE To determine the effect of Mathieu and tubularized incised plate (TIP) urethroplasty techniques on the outcome of repair in recurrent hypospadias. MATERIAL AND METHODS A total of 78 patients who had undergone surgical correction by either Mathieu or TIP urethroplasty after unsuccessful hypospadias surgery were enrolled in this study. Cases were divided into two groups according to the operation technique performed. Surgical success rate of the techniques and the prognostic significance of age, type of diversion used, caliber and length of new urethra, and the number of previous operations were analyzed statistically. RESULTS Mathieu and TIP urethroplasties were performed in 57 and 21 patients, respectively. No statistically significant relation was found between the groups for age, length of new urethra created, caliber of the urethra, urinary diversion used, mean operation success rates and number of previous operations. From within-group analysis, Mathieu urethroplasty was found to have a statistically significant relationship with the number of previous operations (P=0.025, Mann-Whitney U-test). CONCLUSIONS Age, length and caliber of new urethra, and diversion type used seem to have no effect on the success rate of Mathieu and TIP urethroplasty in recurrent hypospadias restoration. The success of the Mathieu operation diminished proportionally to the number of previous failed surgeries.

Management of post-traumatic arterial priapism in children: Presentation of a case and review of the literature

In this article, a 9-year-old boy with arterial priapism is presented. The patient was managed with the conservative measures including imipramine hydrochloride and a favorable outcome was achieved after 2 months of follow-up. The pathophysiology, diagnostic tools and treatment alternatives are discussed.

Calyceal fornix rupture during cystography

We report the first case of calyceal fornix rupture due to cystography in the literature. We recommend that instillation of all the contrast material should be attentively traced by the fluoroscope during cystography.