Halil Ciftci

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.

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.

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.

Polyorchidism: a three-case report and review of the literature

The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2‐year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients’ supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed‐up in the long term.

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.

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction.

OBJECTIVES: To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity. METHODS: Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate. RESULTS: Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1±0.0 vs. 1.6±0.0 µmol H2O2 Eq/L, 10.3±1.1 vs. 6.9±1.2 µmol H2O2 Eq/L, and 236.4±19.5 vs. 228.2±19.2 U/L, respectively (p<0.0001 for all). CONCLUSIONS: Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.

Can the mean platelet volume be a risk factor for vasculogenic erectile dysfunction

Purpose The mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. We aimed to investigate the association between MPV and vasculogenic erectile dysfunction (ED). Materials and Methods MPV and platelet (PLT) levels were measured in 50 cases of ED and 40 healthy controls. The diagnosis of vasculogenic ED was based on a detailed sexual history, physical examination, laboratory assessment, and color Doppler ultrasonography. The results are given as mean±standard deviation of the mean. Results The mean ages of the patient and the control groups were 53.70±12.39 years (range 24~77 years) and 53.85±9.5 years (range 30~73 years), respectively (p=0.947). The MPV and PLT values were significantly higher in the patients with ED than those of the controls (7.49±1.4), (6.85±1.2), (262.97±68), (252.89±82) respectively, p<0.001). However, the MPV values were not statistically significantly different in the patients with severe ED according to the International Index of Erectile Function than in those with mild ED, p>0.05), and there was no correlation between MPV and either age of patients (p=0.905) or duration of ED (p=0.583). Conclusions The platelet count and MPV was detected to be increased in patients with vasculogenic ED. This finding suggests a role for platelets in the pathogenesis of vascular complications and that the MPV would be useful in monitoring disease progression.

Chronic Orchialgia and Associated Diseases

Objective: Chronic scrotal pain (CSP) is one of the difficult medical evaluations. Approximately 25% of patients with chronic orchialgia have no obvious cause for the pain. The aim of this study was to identify the frequency of CSP in daily urological practice and associated diseases for our patients. Patients and Methods: In this study, 2,375 men over 18 years of age who applied to the urology outpatient clinics in our city from March 2007 to June 2007 were evaluated for chronic unilateral, bilateral or mixed orchialgia. Also evaluated was the pain score on a scale of 0 (no pain) to 10 (pain as bad as imaginable), duration of pain and pain location. Results: CSP was identified in 4.75% of the patients (113/2,375), with a mean age of 32.5 ± 10 years, and a range of 18–55 years. Associated diseases were: untidy sexual intercourse (19.5%), normal (18.6%), infertility (9.7%), varicocele (8.8%), medium and lower ureteral stones (7.1%), chronic prostatitis (5.3%), lumber pain (4.4%), stress (4.4%), epididymal cysts (4.4%), irritable bowel (4.4%), infection (3.5%), previous operation (2.7%), driving (2.7%), hernia (2.7%), and hydrocele (1.8%). Conclusion: CSP has an important place in daily urology practice with a frequency of 4.75%. It is very important to identify the reasons lying behind it and to plan effective treatment in the name of preventive medicine.