Ercüment Ulusoy

The Prevalence of Female Sexual Dysfunction and Potential Risk Factors That May Impair Sexual Function in Turkish Women

Objectives: To detect the prevalence of sexual dysfunction, and also to investigate possible risk factors that may cause sexual dysfunction in the Turkish women. Materials and Methods: The study consisted of 179 women between the ages of 18 and 66 years living in households from different sociocultural areas. The women were divided into 5 groups according to their ages: 18–27 years (n = 23), 28–37 years (n = 55), 38–47 years (n = 43), 48–57 years (n = 44) and 58–67 years (n = 14). Female sexual function was evaluated with a detailed 19-item questionnaire to assess desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was calculated for each domain and compared among the groups. In addition, demographic characteristics and medical risk factors were assessed in all women, and the findings were compared between the women with and without sexual dysfunction. Results: Based on total sexual function score, 84 (46.9%) out of 179 women had sexual dysfunction. The prevalence of female sexual dysfunction was 21.7% in the ages of 18–27 years, 25.5% in the ages of 28–37 years, 53.5% in the ages of 38–47 years, 65.9% in the ages of 48–57 years and 92.9% in the ages of 58–67 years. The prevalence of sexual dysfunction for each domain also increased with age. To investigate various factors that may cause female sexual dysfunction, no significant differences were detected in smoking history (p = 0.14), marriage age (p = 0.7), the presence of previous pelvic surgery (p = 0.09), and contraception methods used (p = 0.31). However, sexual dysfunction was observed as significantly higher in the presence of older age (p = 0.001), lower educational level (p = 0.012), unemployment status (p = 0.017), chronic disease (p = 0.032), multiparity (p = 0.0027) and menopause status (p = 0.0001). Conclusions: The prevalence of female sexual dysfunction including desire, arousal, lubrication, orgasm, satisfaction and pain problems increases with age. In addition, the presence of a lower educational level, unemployment status, chronic diseases, multiparity and menopause status are important risk factors that may cause sexual dysfunction.

The Effect of Varicocele Repair on Testicular Volume in Children And Adolescents With Varicocele

PURPOSE We investigated the effect of varicocele repair on testicular volume according to age in children and adolescents and review the long-term results of varicocele surgery. MATERIALS AND METHODS The study included 39 boys 11 to 19 years old with clinical palpable varicocele who underwent varicocele surgery with at least 1 year of postoperative followup. Preoperative and postoperative testicular volumes were monitored and measured with an ellipsoid Prader orchidometer. Physical examination findings (testicular volumes and testicular consistency) in all boys, and serum hormone values and semen parameters in 16 adolescents were recorded and compared before and after surgery. RESULTS Left unilateral varicocelectomy was done in 29 boys (74%) and bilateral varicocelectomy in 10 (26%). While no postoperative hematoma, infection or testicular atrophy was observed, 1 boy (2.5%) had varicocele recurrence and 2 boys (5.1%) had minimal hydroceles that required no intervention. Significant increases were observed in postoperative sperm concentration (p = 0.01), total motile sperm count (p = 0.009), testis volume (p = 0.000) and serum testosterone level (p = 0.014). All 15 boys with preoperative soft testis had normal testicular consistency postoperatively. Of the 19 boys with preoperative testicular atrophy 10 (53%) did regain normal testicular growth, while 9 (47%) retained testicular volume loss after surgery. When comparing preoperative to postoperative increase in testicular volume according to age in all boys, the mean was statistically significantly higher in boys younger than 14 years (left testis p = 0.037, right testis p = 0.000). CONCLUSIONS Testicular consistency achieved normal firmness after varicocelectomy in all boys with preoperative soft testis. While there was catch-up growth in comparison to the contralateral testis, testicular consistency improved but testicular volumes may not increase significantly after varicocele repair at ages older than 14 years. However, in these adolescents postoperative semen parameters and serum hormone values may significantly improve regardless of testicular volume. Therefore, boys with varicocele and their families should be fully informed in light of these findings.

Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume

Introduction: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. Patients and Methods: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. Results: The mean age of the boys was 13.5 ± 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). Conclusions: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.

Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis

OBJECTIVES To investigate in a prospective study the role of bladder function and to compare the results of urinary tract ultrasonography and urinalysis in children with and without primary nocturnal enuresis because, although this is a common problem in children, the etiology and mechanisms of the disorder have not been elucidated. METHODS The study included 106 children with monosymptomatic primary nocturnal enuresis and a control group of 57 children with no history of voiding dysfunction, aged 5 to 19 years. All children underwent urinalysis, bladder and upper urinary tract ultrasonography, and uroflowmetry. The bladder capacity, bladder wall thickness, and postvoid residual volume were measured using ultrasonography. The findings were compared between the enuresis and control groups according to age: 5 to 9 years, 10 to 14 years, and 15 to 19 years. RESULTS The mean age was 9.6 +/- 3.1 years in the nocturnal enuresis group and 9.4 +/- 3.3 years in the control group (P = 0.727). The mean number of defecations per week was significantly lower statistically in the enuresis group than in the control group in the age categories of 5 to 9 years and 10 to 14 years (P = 0.038 and P = 0.018, respectively), and the mean number of urinations per day was significantly higher statistically in the enuresis group than in the control group in the age groups of 5 to 9 years and 10 to 14 years (P = 0.002 and P = 0.001, respectively). The bladder capacity, bladder wall thickness, postvoid residual volume, uroflowmetry maximal flow rate, and average flow rate were not significantly different statistically between the children with primary nocturnal enuresis and the control group in the three age brackets. Urinary infection was detected in 2 children (1.88%) in the nocturnal enuresis group and none of the children in the control group (P = 0.547). Upper urinary tract abnormalities detected by ultrasonography were seen in 3 children (2.83%) in the nocturnal enuresis group and 1 child (1.75%) in the control group, revealing no statistical significance (P = 0.671). CONCLUSIONS Our findings show that the ultrasonographic and uroflowmetry findings on bladder function and the upper urinary system and the incidence of urinary infection are similar in children with and without nocturnal enuresis. Obtaining a voiding and elimination diary in conjunction with a good history may be beneficial in children with monosymptomatic primary nocturnal enuresis. In addition, routine urinalysis may be unnecessary in the evaluation of children with monosymptomatic primary nocturnal enuresis after obtaining a careful and complete history of the voiding dysfunction.

The assessment of constipation in monosymptomatic primary nocturnal enuresis

Objective: Nocturnal enuresis and constipation are common pediatric problems. The aim of this study was to assess the incidence of constipation in children with or without monosymptomatic primary nocturnal enuresis.Methods: The study included 5350 children, ages 5–19 years, who were surveyed to detect the incidence of nocturnal enuresis. Of those surveyed, 679 (12.7%) had primary nocturnal enuresis. All children were questioned by mail with a standard form that addressed their micturition and defecation habits. The children those who had primary nocturnal enuresis were invited to the Pediatric Urology Section of the University Hospital. Of those 679 children, 125 kept that invitation. All 125 of those children underwent an abdominal ultrasound. Also, these children had serum creatinine levels drawn and plain abdominal films taken.Results: Constipation, defined as less than 3 bowel movements per week, was seen in 48 of 679 children with nocturnal enuresis (7.06%). Of those 4671 children without nocturnal enuresis, only 68 (1.45%) had constipation. The difference in constipation between the two groups was statistically significant (z = −9.251; p = 0.000). Of note, 10 of the 125 children (8%), evaluated at the hospital, had constipation. None of the children had an abnormal neurologic examination. Finally, faecal loading was detected on the plain films of 8 of the 125 children evaluated, 7 of who had constipation. The sensitivity of grading plain films for faecal loading to denote constipation in this population was 87.5%.Conclusions: Children with primary nocturnal enuresis should be thoroughly assessed for coexisting constipation.

Periprostatic Lidocaine Infiltration and/or Synthetic Opioid (Meperidine or Tramadol) Administration Have No Analgesic Benefit during Prostate Biopsy

Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the analgesic effect of periprostatic nerve block and/or intravenous synthetic opioid administration during a 12-core prostate biopsy. Patients and Methods: Patients were prospectively randomized to receive unilateral periprostatic lidocaine administration and/or intravenous synthetic opioid (meperidine or tramadol) administration. Placebo groups received sterile normal saline. Unilateral infiltration was performed and biopsy was begun on this side. The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score before the procedure, during probe introduction into the rectum, during unilateral periprostatic nerve blockade, during the first 6-core biopsy and during the second 6-core biopsy, and 30 min after biopsy completion. Results: Most of the patients had mild or moderate pain (VAS/NAS <6) during the actual biopsy procedure. However, no significant differences existed between the groups with regard to the pain scores at any time (p > 0.05). Compared with pain scores, no significant differences existed between the first 6-core (blocked side) and second 6-core biopsies (p > 0.05). Conclusion: Periprostatic lidocaine infiltration and/or intravenous synthetic opioid analgesics are not beneficial in significantly reducing pain during biopsy. We think that most of the patients do have pain during biopsy, however the intensity of pain is tolerable and does not require analgesics.

A comparison of four different a1-blockers in benign prostatic hyperplasia patients with and without diabetes

Objective: The aim of this study was to evaluate the intensity of lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) with and without diabetes. We also determined whether α1-blockers improve subjective and objective symptoms similarly in these patients. Material and Methods: The study subjects comprised 281 patients (60 with diabetes and 221 non-diabetics with clinically diagnosed BPH) who were treated with α1-blockers (doxazosin, terazosin, alfuzosin and tamsulosin). The international prostate symptom score (IPSS), bother score, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were determined at baseline and after treatment for a minimum of 6 months. Results: Diabetic patients had a lower baseline Qmax than non-diabetics (p < 0.001), while the IPSS, bother score and PVR did not differ significantly between the two groups. After treatment with α1-blockers, lower urinary tract symptoms improved significantly. The improvement rates of the IPSS and bother score were significantly higher in the diabetic patients than in the non-diabetics (p < 0.01). The relationship between the duration of diabetes and the effect of α1-blockers on IPSS, bother score, Qmax and PVR was not statistically significant (p > 0.05). Conclusions: The voiding function of the bladder may be more affected by diabetes than the storage function in patients with BPH. Treatment with α1-blockers appears to be useful for diabetic patients with BPH and its effectiveness is not altered by the duration of diabetes.

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom Score

Objectives: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self‐administered by the patient. The effect of the patients educational level on the IPSS was also evaluated.

Effect of terazosin on the lipid profile in patients with symptomatic benign prostatic hyperplasia.

Introduction: To determine the changes in plasma lipid levels in symptomatic benign prostatic hyperplasia (BPH) patients receiving terazosin treatment. Materials and Methods: The study included 99 patients with BPH aged 44–74 years. The patients were divided into 3 groups: in group 1 (n = 25) with baseline total cholesterol levels of >220 mg/dl, terazosin 5 mg/day was used; in group 2 (n = 56) with basal total cholesterol levels of < 220 mg/dl, terazosin 5 mg/day was used, and group 3 (n = 18) did not use terazosin and was defined as the control group. Plasma levels of total cholesterol, low-density lipoprotein, high-density lipoprotein and triglyceride were recorded, and the high-density lipoprotein to total cholesterol ratio was calculated at the beginning of the study and after 12 weeks. Results: The total cholesterol level decreased from the baseline level by 10.88% after 12 weeks (p < 0.05) in group 1. The decrease was observed in 22 of 25 patients (88%). In group 1, the mean plasma total cholesterol level decreased significantly (p < 0.05), but the decrease was not significant in group 2 and no change was observed in group 3. The mean plasma low-density lipoprotein level decreased significantly in group 1 (p < 0.05), but no change was observed in the other 2 groups. The mean plasma high-density lipoprotein level increased in group 1, whereas no change was observed in the other 2 groups. The mean plasma triglyceride level decreased significantly in groups 1 and 2 (p < 0.05), but no change was observed in group 3. The high-density lipoprotein to total cholesterol ratio increased significantly in group 1, but no change was observed in the other 2 groups. Conclusion: We suggest that terazosin may be a reasonable choice because of the beneficial effect on the lipid profile in older symptomatic BPH patients with a higher ratio of dyslipidemia.