Ayhan Verit

The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence

The aim of this study was to evaluate the effects of tension-free vaginal tape (TVT) on sexual function in women with stress urinary incontinence (SUI) by questionnaire. Thirty-two sexually active and married women who were planned for TVT to treat SUI constituted the patient group, and 25 women who were healthy, sexually active and married, were selected as the control group; the ages of both groups matched. Sexual functions (desire, arousal, orgasm, pain and satisfaction) were evaluated with the Index of Female Sexual Function (IFSF), and continence status during sexual intercourse was asked about both preoperatively and postoperatively in the 6th month. The mean domain scores of sexual functions such as desire, arousal, orgasm, pain and overall satisfaction preoperatively and postoperatively were 3.37±0.69, 3.82±0.62, 3.40±0.95, 3.41±0.98, 3.16±1.09 and 3.32±0.79, 3.71±0.53, 3.06±1.04, 2.75±1.29, 2.88±0.63, respectively, and postoperative scores insignificantly decreased. Also, these scores in the control group were 3.64±0.66, 3.96±0.73, 4.12±0.78, 3.96±1.14 and 3.68±0.92. In comparison with the control group, whereas all of the preoperative domain scores were found to be decreased but were statistically insignificant except orgasmic function, postoperative scores significantly worsened, except for desire and arousal. However, preoperatively nine patients explained that they had incontinence during sexual intercourse, and this problem persisted in twopostoperatively (p = 0.043). This study shows that both SUI and the TVT procedure negatively affect sexual function in women.

Effects of N-acetylcysteine on Semen Parameters and Oxidative/Antioxidant Status

OBJECTIVES To examine whether a beneficial effect of N-acetylcysteine (NAC) on semen parameters and oxidative/antioxidant status in idiopathic male infertility exists. The production of reactive oxygen species is a normal physiologic event in various organs. However, overproduction of reactive oxygen species can be detrimental to sperm and has been associated with male infertility. METHODS Our study included 120 patients who had attended our clinic and were diagnosed with idiopathic infertility according to medical history and physical and seminal examination findings, as initial evaluations. The patients were divided randomly into 2 groups. Those in the study group (60 men) were given NAC (600 mg/d orally) for 3 months; the control group (60 men) received a placebo. The oxidative status was determined by measuring the total antioxidant capacity, total peroxide and oxidative stress index in plasma samples. The sperm parameters were evaluated after NAC treatment and were compared with those in the control group. RESULTS NAC had significant improving effects on the volume, motility, and viscosity of semen. After NAC treatment, the serum total antioxidant capacity was greater and the total peroxide and oxidative stress index were lower in the NAC-treated group compared with the control group. These beneficial effects resulted from reduced reactive oxygen species in the serum and reduced viscosity of the semen. No significant differences were found in the number or morphology of the sperm between the 2 groups. CONCLUSIONS We believe that NAC could improve some semen parameters and the oxidative/antioxidant status in patients with male infertility.

Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study

Abstract Background: The purpose of the study was to compare the effect of varicocelectomy with that of clomiphene citrate on seminal improvement and pregnancy rates in patients with subclinical varicocele.

No increase in sperm DNA damage and seminal oxidative stress in patients with idiopathic infertility

The most common cause of male infertility is idiopathic. Standard investigations reveal no abnormality in such cases. The aim of the study was to investigate the levels of sperm DNA damage and seminal oxidative stress and their relationships with idiopathic infertility. The study included 30 normozoospermic infertile men seeking infertility treatment and 20 fertile donors. Semen analysis was performed according to the World Health Organization guidelines. Sperm DNA damage was assessed by alkaline single cell gel electrophoresis (comet assay) after preparation with two-step discontinuous Percoll gradient. Seminal oxidative stress was measured by a novel automated method. DNA damage score, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) were not different in idiopathic infertile men compared with controls. No correlations were also found between DNA damage score and TAS, TOS levels and OSI in idiopathic infertile group. We did not find any relationship between sperm DNA damage and oxidative stress in normozoospermic infertile men. We think that the pathophysiology of idiopathic infertility cannot be explained by sperm DNA damage or seminal oxidative stress.

Low sexual function and its associated risk factors in pre- and postmenopausal women without clinically significant depression

OBJECTIVES To investigate the low sexual function and its associated risk factors in pre- and postmenopausal women without clinically significant depression. METHODS Cross-sectional study with 180 women aged between 19 and 60 years who admitted to our outpatient clinic. Sexual function was assessed by female sexual function index and clinically significant depression was measured by Beck depression inventory test. RESULTS The rate of low sexual function was 85.9% in postmenopausal (OR 2.9, 95% CI 1.8-4.8) and 47.7% in premenopausal women (OR 0.4, 95% CI 0.3-0.5) (p<0.0001). The postmenopausal group reported significantly lower desire, arousal, lubrication, orgasm, satisfaction and pain scores than controls (p<0.0001, for all of them). Low sexual function was positively correlated with age (r=0.37, p<0.0001), menopausal status (r=0.40, p<0.0001), gravidity (r=0.44, p<0.0001), parity (r=0.43, p<0.0001), abortion rates (r=0.27, p=0.001) and marriage period (r=0.40, p<0.0001). There were also significant negative correlations between low sexual function and education (r=-0.39, p<0.0001) and family income (r=-0.29, p<0.0001). However, multivariate regression analysis demonstrated that education, family income and menopausal status were the only independent variables for low sexual function after adjusted for age, gravidity, parity, abortion, marriage period and menopausal status. CONCLUSION Low sexual function was relatively high in postmenopausal women without clinically significant depression. Education, family income and menopausal status were the independent risk factors for low sexual function. Investigation of female sexuality was essential for these patients.

FOURNIER'S gangrene: the development of a classical pathology.

Necrotizing fasciitis, especially when termed Fournier’s gangrene (FG) when it initiates at the perineum, is a rare but rapidly progressive subcutaneous tissue infection characterized by extensive necrosis. Although it has been known for more than a century and considered as a cause of death, the basic medical principles have not changed for many years. We discuss what is new in the evaluation of this enigmatic pathology and speculate about its clinical metamorphosis. We reviewed reports of FG in the English language. The clinical characteristics of FG have been changing; atypical locations of necrotizing fasciitis, e.g. in the head and neck, and the incidence of patients with FG but no predisposing factors, has been increasing. While the role of anaerobic bacteria in FG is decreasing, that of atypical organisms is increasing, and thus hyperbaric oxygen therapy will probably cease to be a common treatment. We think that FG will not be as likely to cause death in future.

Paraoxonase‐1 Activity in Subfertile Men and Relationship to Sperm Parameters

Oxidative stress has been implicated in the pathogenesis of male infertility. Paraoxonase-1 (PON-1) is a high-density lipoprotein-associated antioxidant enzyme that prevents oxidative modification of low-density lipoprotein. Our aims in the study were to investigate 1) seminal PON-1 activity in subfertile men and 2) whether seminal PON-1 activity had any relationship to semen parameters. The study included 28 men with idiopathic subfertility, 32 subfertile men with abnormal semen parameters, and 30 fertile male volunteers. Seminal PON-1 activity was measured spectrophotometrically. Seminal total antioxidant status (TAS) and total oxidant status (TOS) were determined by using colorimetric methods. Oxidative stress index (OSI) was calculated as ([TOS/TAS] x 100). TOS and OSI were significantly higher and PON-1 activity and TAS were significantly lower in subfertile men with abnormal semen parameters than in men with idiopathic subfertility and fertile donors. PON-1 activity was also strongly correlated with sperm concentration (r = .68, P < .0001), motility (r = .58, P < .0001), and morphology (r = .62, P < .0001) in the overall group. The receiver operating characteristic curve analysis revealed a high diagnostic value for PON-1 activity with respect to male-factor subfertility, with an area under curve of .95 (95% confidence interval = 0.89-1.01), sensitivity = 97%, and specificity = 88%. Men with abnormal semen parameters have decreased levels of PON-1 activity in their seminal plasma. This may play an important role in the pathogenesis of male-factor subfertility.

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.

The antioxidant role of oral administration of garlic oil on renal ischemia-reperfusion injury.

Aim: In this study we examined the effect of oral application of garlic form [garlic oil (GO)] on rats after renal ischemia–reperfusion (I/R) injury. Materials and methods: Forty male Wistar albino rats were divided into four groups: control, sham-operated, I/R, and I/R + GO. GO was diluted in water and administered by oral intubation three times each week for 6 weeks. All rats except sham-operated underwent 45 min of bilateral renal ischemia followed by 6 hr of reperfusion. Blood samples and kidney tissues were harvested from the rats, and then rats were killed. Serum urea, creatinine, and cystatin C levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), nitrite oxide (NO), and protein carbonyl (PC) levels in kidney tissue and blood were measured. In addition, kidney tissue histopathology was evaluated. Results: The serum urea, creatinine, and cystatin C levels were significantly higher in I/R group compared to I/R + GO group (p < 0.01). The serum and tissue antioxidant markers (TAC, CAT) were significantly lower in I/R group than I/R + GO group (p < 0.01). The serum oxidant markers (TOS, MPO, NO, and PC) were significantly higher in I/R group than I/R + GO group (p < 0.01). Also oral application of GO was effective in decreasing of tubular necrosis score. Conclusion: Based on the present data, we conclude that increased antioxidants and decreased oxidants modulated by oral application of GO attenuated the renal I/R injury.

The Association of Serum Prolidase Activity and Erectile Dysfunction

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with carboxy-terminal proline or hydroxyproline and plays a major role in collagen turnover. Collagen is the essential content in atherosclerotic plaque, playing a key role in the stability/instability and progression of endothelial dysfunction in the pathogenesis of erectile dysfunction (ED). Consequently, in this study we sought to determine serum prolidase activity and markers of oxidative stress, such as lipid hydroperoxide and total free sulfhydryl, in vasculogenic ED. We evaluated 92 patients with vasculogenic ED and 50 control subjects by clinical and laboratory investigations. We measured serum prolidase activity and serum total free sulfhydryl levels spectrophotometrically. Serum lipid hydroperoxide levels were determined with ferrous ion oxidation-xylenol orange method. We assessed the association of serum prolidase activity with the presence and severity of vasculogenic ED and clinical characteristics, as well as laboratory parameters. We also assessed the association of serum prolidase activity with the variables according to the vascular status of patients with vasculogenic ED. The comparison included 92 vasculogenic ED patients grouped into 3 categories according to the vascular status of patients with ED-arterial insufficiency (n = 26), veno-occlusive dysfunction (n = 37), and mixed-type impotence (n = 29)-and 50 controls. Receiver-operator characteristics (ROCs) were analyzed to find a cutoff value with the best sensitivity and lowest false-positive rate. Serum prolidase activity (53.5 +/- 5.5 U/L vs 45.7 +/- 4.9 U/L, respectively; P < .001) and serum lipid hydroperoxide levels were significantly increased in patients with vasculogenic ED compared with controls, whereas serum total free sulfhydryl levels were significantly decreased in patients with vasculogenic ED compared with controls (P < .001). The lowest and highest mean serum prolidase activities were detected in control participants and in patients with arterial insufficiency, respectively (analysis of variance P < .001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 0.78. Findings of this study have shown that serum prolidase activity is significantly associated with the presence and severity of vasculogenic ED, and elevated serum prolidase activity might be an independent predictor of ED.