Hakan Gulmez

Comparison of Alpha Blockers in Treatment of Premature Ejaculation: A Pilot Clinical Trial

Background: Premature ejaculation (PE) is the most common sexual disorder in men and studies reported prevalence up to 30% (1, 2). PE is not a life-threatening medical condition but it influences the quality of life (QoL). Objectives: The aim of this study was to compare the efficiency, and safety of alpha blocker drugs in the treatment of patients with premature ejaculation (PE). Additionally we investigated the quality of life (QoL) in patients with PE who were treated with alpha blocker drugs. Materials and Methods: This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n = 21), tamsulosin hydrochloride 0.4mg (Group 2, n = 23), alfuzosin 10mg (Group 3, n = 22), terazosin 5mg (Group 4, n = 21), doksazosin mesylate 4mg (Group5, n = 21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P < 0.05 was considered statistically significant. Results: All alpha blocker drugs were statistically effective for preventing PE. Notably, silodosin seemed to be more effective for preventing PE than other alpha blockers (P < 0.05). However all alpha blockers provided development in QoL scores, silodosin was a little better than other drugs in statistical analyses. Furthermore statistical increase in IELT and decrease in PEP were provided more in Group 1 than other groups (P < 0.05). Conclusions: Silodosin seems to be able to even more prevent PE. Silodosin may provide development in QoL than other alpha blocker agents. Additionally, lower systemic adverse events and more effectivity are the prominent features of silodosin in PE.This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n = 21), tamsulosin hydrochloride 0.4mg (Group 2, n = 23), alfuzosin 10mg (Group 3, n = 22), terazosin 5mg (Group 4, n = 21), doksazosin mesylate 4mg (Group5, n = 21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P < 0.05 was considered statistically significant.

Impact of Iron Supplementation on Sexual Dysfunction of Women with Iron Deficiency Anemia in Short Term: A Preliminary Study

INTRODUCTION Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide. It is an important health problem especially in women of reproductive age. IDA may cause anxiety, which is the major factor for female sexual dysfunction (FSD). AIM The aim of the present study was to determine the impact of IDA on FSD in women of reproductive age. METHODS In total, 207 women were enrolled. Women with IDA who were admitted in an outpatient clinic of family medicine were asked to complete Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and Quality of Life (QoL) questionnaires. Questionnaires were completed before and after IDA treatments. Blood samples were obtained for measurements of hemoglobin, hematocrit, levels of serum iron, and iron-binding capacity. MAIN OUTCOME MEASURES Outcomes of blood samples were used for diagnosing of IDA. BAI, FSFI, and QoL scores were evaluated. Paired samples t-tests and Pearson correlation analyses were used to assess relationship between findings of IDA treatments and other parameters. RESULTS The mean age was 33.6 ± 8.4 years. There were statistical significant differences between pre- and posttreatment in terms of hemoglobin, hematocrit, serum iron, and serum iron-binding capacity. BAI scores were decreased and FSFI scores, which were statistically significant, increased after IDA treatments (P < 0.001). However, QoL scores were developed without statistical significance. CONCLUSION There is a risk for anxiety as well as FSD in IDA women of reproductive age. Treatment of IDA can significantly improve sexual functions and QoL in these women population in short term.

Usage of neck circumference as novel indicator of erectile dysfunction: a pilot study in Turkish population

Erectile dysfunction (ED) is the most common male sexual problem worldwide. The association between ED and components of metabolic syndrome (MtS) is well established. This study examined neck circumference (NC) as a possible indicator of MtS and also of ED. Ninety‐two patients were included and divided into two groups. Group 1 consisted of 47 patients with ED and Group 2 consisted of 45 healthy volunteers. Questionnaires, differences in anthropometric and laboratory measurements between patients with ED and the control group, and a cut‐off value for NC were investigated. The mean NC in ED patients was higher in Group 1 than in Group 2 (P = 0.001), and Group 1 also demonstrated more MtS criteria than Group 2 (P < 0.001). The cut‐off point of NC was defined as 34.75 cm for ED and MtS. The cut‐off values of waist circumference for ED and MtS were 105.5 and 102.5 cm respectively. In the light of these findings, NC may be a new component of MtS in ED patients. Additionally, NC may be a novel indicator of central obesity and ED. We suggest that NC values of 35 cm and over may predict ED in patients with MtS.

Impact of Rho-Kinase Inhibitor Hydroxyfasudil in Protamine Sulphate Induced Cystitis Rat Bladder

The objective of the present study was to evaluate anti‐inflammatory effects of hydroxyfasudil in a protamine sulfate (PS) induced cystitis rat model. Additionally, we investigated prevention of bladder overactivity (BO), and tissue damage in these experiments.

Retrospective study of endoscopic treatment in children with primary vesicoureteral reflux and multivariate analysis of factors for failure.

Abstract Objective. The aim of this study was to investigate endoscopic treatment in children with primary vesicoureteral reflux (VUR) and conduct a multivariate analysis of factors for failure. Material and methods. Between August 2006 and January 2012, 216 children (32 boys and 184 girls) with primary VUR (grades I–IV) who underwent endoscopic treatment were analysed. Patients with grade V VUR were excluded. Hydrodistension tests and intraureteral injection techniques were performed, if applicable. Urinary ultrasound and voiding cystourethrography were studied 3–6 months after surgery. Univariate and multivariate logistic regression were used for statistical analyses. Results. In total, 172 children (21 boys and 151 girls) were enrolled, and 280 ureters were treated (108 bilateral, 64 unilateral; three with grade I, 34 with grade II, 214 with grade III and 29 with grade IV VUR). The median (± SD) age was 7.8 ± 3.1 years (boys 7 ± 3.1 years, girls 7.9 ± 3.1 years). The mean (± SD) follow-up was 24.4 ± 4.1 months (boys 28.2 ± 8.1 months, girls 21.4 ± 4.1 months). Mean injected volume per ureter was 1.8 ± 0.5 ml. A single injection resolved the reflux in 79.6% and a second injection resolved it in 90.4% of ureters. Eight children (4.6%) had postoperative febrile urinary tract infections (fUTIs). Postoperative fUTIs were significantly associated with failures in injection (p < 0.001). Renal scars were significantly associated with postoperative fUTI (p = 0.006). Haematuria occurred in three children (minor complication); a non-functional kidney was observed in one child (major complication) and a laparoscopic nephrectomy was performed. Fourteen children underwent ureteroneocystostomy owing to unsuccessful VUR treatment. Conclusions. Endoscopic injection of small-diameter microsphere (80–120 μm) non-animal dextranomer–hyaluronic acid copolymer seems to be an effective treatment for VUR. Only postoperative fUTI and the presence of a renal scar were correlated with failed endoscopic treatment of VUR.

Comparsion between Tubeless and Standard Nephrolithotomy of Renal Resistive Index in Kidneys of Patients

Objective: We aimed to compare renal injury and vasculary resistance between standard and tubeless percutaneous nephrolithotomy (PCNL), in patients who were operated for kidney stone, by using colored Doppler ultrasonography (CDU). Methods: All consecutive PCNLs were evaluated between 2009 and 2011. The patients with access to the kidney provided in the lower pole and who visited our outpatient clinic regularly were enrolled in the study. Patients were divided into 2 groups; patients who had standard PCNL were included in Group 1 (n=22) and patients who had tubeless PCNL were included in Group 2 (n=21). The demographic data were collected from files of patients and were recorded. CDU was performed in all patients for evaluating resistive index (RI), parenchymal thickness and parenchymal echogenity before operation, after operation early postoperative (after 7 days nephrostomy catheter was taken off in Group 1, 7 days from operation in Group 2) and midterm postoperative period (6 months after operation). Statistical significant p was accepted as p<0.05. Results: Mean age was 47.18±1.3 years. There were 8 female and 14 male patients in Group 1 (n=22), 4 female and 17 male patients in Group 2 (n=21). The mean follow-up was 10.71±1.2 months. There was no statistical difference for mean age, body mass index, stone burden, serum creatine, hemoglobin, delta hemoglobin, complications, urinary culture, stone free rate between groups. Hospital stay was longer in Group 1 than Group 2 (p=0.04). Mean operation time was shorter in Group 2 than Group 1 (p=0.002). In the comparison of before and early postoperative operation, there were differences in groups for CDU, including RI, parenchymal thickness. There was an increase for RI and decrease for parenchymal thickness in midterm follow-up period when comparing RI before operation in the lower pole of the operated kidney. There was no difference in renal echogenity in CDU in groups between before and mid-term follow-up period. Conclusion: Recently, PCNL has been employed as a minimally invasive and safe procedure for kidney stones bigger than 2 cm. Tubeless PCNL was successful as standard PCNL, provided shorter hospital stay than standard PCNL and caused less damage to the kidney in the early follow-up period. (JAREM 2013; 3: 19-23)