Erdem Akbay

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 Assessment of Sexual Functions in Women with Male Partners Complaining of Erectile Dysfunction: Does Treatment of Male Sexual Dysfunction Improve Female Partner's Sexual Functions?

The aims of this prospective study were to compare sexual functioning between women with male partners who have erectile dysfunction (ED) and women without partners with ED and also to investigate the effect of the treatment of male ED on female partners sexual function. The study included 87 women and their male partners. We divided the women into two groups: 38 women with male partners complaining of ED (ED group) and 49 women with male partners who have no ED (control group). Of the men with ED, 30 were treated with penile prosthesis implantation (n = 17) or oral sildenafil citrate (n = 13). We evaluated all the men with the International Index of Erectile Function (IIEF; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999), physical examination, and color penile Doppler ultrasound. We evaluated female sexual function with the Female Sexual Function Index (FSFI; Rosen et al., 2000) to assess sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. We compared female sexual function scores between the women of the male partners with and without ED and also compared before both groups and after the treatment of male partners in the ED group. Additionally, we compare the scores according to the type of treatment given to the male partners. Sexual arousal (p = 0.009), lubrication (p = 0.001), orgasm (p = 0.006), satisfaction (p = 0.000), pain (p = 0.039), and total score (p = 0.003) were highly significantly lower in the ED group than in the control group, although sexual desire did not differ between the two groups (p = 0.515). We investigated the effect of male ED on female sexual functions and found no statistically significant differences in the presence of organic type impotence, older age, and lower erection scores on the IIEF (p = 0.53, p = 0.15, and p = 0.1, respectively). After the treatment of male ED, we observed significant improvement in sexual arousal (p = 0.001), lubrication (p = 0.002), orgasm (p = 0.000), satisfaction (p = 0.000), and pain (p = 0.002) in the women. These findings suggest that female sexual function is affected by male erection status and may improve after the treatment of male sexual dysfunction.

The prevalence of varicocele and varicocele‐related testicular atrophy in Turkish children and adolescents

Objective To determine the prevalence and site of varicocele and varicocele‐related testicular atrophy in children and adolescents.

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.

Mast Cells and Fibrosis on Testicular Biopsies in Male Infertility

Testicular dysfunction correlates with increased testicular mast cells. Mast cells can activate fibroblasts and promote collagen synthesis. The aim of the study was to examine testicular mast cells containing tryptase, and the relationship between mast cells and different fibrosis stages of interstitium and peritubular region of testes. Testicular biopsies obtained from 33 infertile men were assigned to 2 groups: normal spermatogenesis ( n = 10) and defective spermatogenesis ( n = 23). Total, interstitial, and peritubular mast cells were examined immunohistochemically using antihuman tryptase. The fibrosis stage was evaluated using vimentin and alpha-smooth muscle actin. The ratio of tubules with sclerosis to total tubules was also calculated. In all cases, mast cells were mainly localized in the interstitium. The number of total mast cells was significantly higher in defective spermatogenesis than in normal spermatogenesis ( p =. 048). In both groups, interstitial mast cells were higher than peritubular mast cells. However, the increase in peritubular region was much higher than the increase in interstitium. Total, peritubular, and interstitialmast cell counts were not different from each other, according to the changing fibrosis stages. Total and interstitial mast cells were significantly higher in the cases with sclerosing seminiferous tubules than in the cases with no sclerosis ( p =. 04 and p =. 024, respectively). The mast cells and the mast cell product tryptase could be involved in the etiology of defective spermatogenesis, especially whenever the last stage (tubular hyalinization and sclerosis) takes place.

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.

The effect of vascular endothelial growth factor on spermatogenesis and apoptosis in experimentally varicocele-induced adolescent rats

OBJECTIVE To investigate the effect of vascular endothelial growth factor (VEGF) injection into the testes on spermatogenesis and apoptosis in a varicocele-induced adolescent rat model. SETTING University hospital urology research laboratory. ANIMAL(S) Six-week-old male Wistar rats (n = 32). INTERVENTION The rats were divided into six groups: control group (n = 6), sham operated group (n = 6), left varicocele-induced group (n = 6), varicocele + varicocelectomy group (n = 6), varicocele + VEGF-injected group (n = 4), and varicocele + varicocelectomy + VEGF-injected group (n = 4). MAIN OUTCOME MEASURE(S) Johnsens score and apoptotic cells. RESULT(S) The mean Johnsens score was lower in the varicocele group compared with in the control and sham groups. The mean apoptotic index was significantly higher in the varicocele group compared with in the control and sham groups. Compared with the varicocele group, the mean apoptotic index was significantly lower in the varicocele + varicocelectomy, varicocele + VEGF, and varicocele + varicocelectomy + VEGF groups. CONCLUSION(S) Varicocele may cause a decrease in spermatogenesis and an increase in the apoptotic index. VEGF may play a positive role in improving testicular damage and may also play a significant role in decreasing apoptosis in a varicocele-induced adolescent rat model.

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.

The efficacy of recombinant human follicle-stimulating hormone in the treatment of various types of male-factor infertility at a single university hospital.

The aim of the study was to prospectively investigate the efficacy of recombinant human follicle-stimulating hormone (rhFSH) in the treatment of various types of male-factor infertility at a single university hospital. The study included 61 infertile men receiving rhFSH because of various type of male infertility. Treatment included 100-150 IU of rhFSH 2-3 times/wk. All men were divided into 4 groups: hypogonadotropic hypogonadism (n = 21), isolated follicle-stimulating hormone (FSH) deficiency (n = 13), idiopathic oligoasthenospermia (n = 16) and maturation arrest on testicular biopsy (n = 11). Total motile sperm count (TMSC), serum FSH level, and testicular volume were compared before and after treatment in all groups. In the hypogonadotropic hypogonadism group, spermatozoa appeared in the ejaculate, with a mean TMSC of 6.67 +/- 1.57 million, in 15 of 21 patients (71.4%) who were totally azoospermic before the treatment. In the isolated FSH deficiency group, TMSC significantly increased from 6.64 +/- 3.27 to 32.4 +/- 9.09 million after the treatment (P = .003). TMSC did not significantly increase in the idiopathic oligoasthenospermia group. Two of the men with maturation arrest (18.1%) had spermatozoa in the ejaculate after the treatment. rhFSH therapy may be effectively used to improve sperm parameters in infertile men with hypogonadotropic hypogonadism and isolated FSH deficiency. In addition, rhFSH may effect some improvement by either providing sperm in ejaculate or increasing intracytoplasmic sperm injection success in infertile men with maturation arrest.