Kadri Anafarta

Alterations of Intracorporeal Structures in Patients with Erectile Dysfunction

Objective: We sought to quantify intracavernosal smooth muscle content (SMC), endothelial cells (EC) and elastic fibres (EF) in both potent and impotent men. We compare the results in impotent men with regard to patient age, aetiology of impotence, presence or absence of diabetes mellitus and smoking. Patients and Methods: Seventy penile biopsies were taken from 10 potent patients with congenital penile curvature (age 17–24 years, mean: 21 ± 1.16) and from 60 impotent patients (age 28–64 years, mean: 46 ± 7.64). Biopsies were stained immunohistochemically to quantify the percentage of SMC by anti-desmin and anti-SMA, anti-CD-34 for EC and Verhoeff’s histochemical staining for EF. Statistical analyses were performed by using one-way Anova after square root transformation. Results: We observed a statistically significant difference in the amounts of corporeal SMC, EC and EF with regard to the following subgroups: potent versus impotent men; men with arterial aetiology versus veno-occlusive aetiology; men under the age of 45 versus men over the age of 45; patients with diabetes mellitus versus non-diabetes mellitus, and smokers versus non-smokers. Conclusion: Quantification of intracavernosal structures appears to be important for either understanding the mechanism of impotence or deciding the appropriate treatment.

Effect of experimental hypercholesterolemia on cavernosal structures.

OBJECTIVESnTo determine the effect of experimental hypercholesterolemia on the ultrastructure of cavernosal smooth muscle cells, endothelial cells, elastic fibers, and collagen content, which are the key structures fundamental for erection.nnnMETHODSnForty-two New Zealand white rabbits were divided into a control group (group 1, n = 7, fed a standard diet), a hypercholesterolemia group (group 2, n = 20, fed a diet containing 1% cholesterol for 8 weeks), and a reversibility group (group 3, n = 15, fed a 1% cholesterol diet for 8 weeks, then switched to a standard diet for 4 weeks). Blood samples were obtained for lipid determination before and after the study. The cavernosal tissues were obtained at the end of 8 weeks for groups 1 and 2 and at the end of 12 weeks for group 3 and immunohistochemical examinations of these cells were performed.nnnRESULTSnImmunohistochemical analysis revealed that hypercholesterolemia produces marked and reversible decreases in the cavernosal content of smooth muscle cells, endothelial cells, and elastic fibers and increases the content of collagen 3 and 4.nnnCONCLUSIONSnOur findings suggest that hypercholesterolemia in this animal model affects the percentage of staining for smooth muscle actin, endothelial cells, elastin, and collagen 3 and 4. However, since this effect is temporary depending on the blood cholesterol levels, it might not alter the erectile function.

The significance of histopathological changes of the normal tunica albuginea in Peyronie's disease

Five patients with Peyronies disease were operated and the tissue specimens from the plaque involving the tunica albuginea and from the tunica of the unaffected contralateral side were obtained. The specimens were then subjected to histopathological examination and the findings were correlated with those of men, proved not to have Peyronies disease but operated for other reasons.In the specimen of plaque, the changes varied from collagen destruction to cartilaginous and osseous metaplasia. However, in the tunica of the contralateral side the changes such as disregularity of collagen bundles extending even to wide-spread focal areas, and apperance of pale, rough, eosinophilic collagen degeneration instead of its characteristic bright birefringence, and focal mucinous degeneration were noted. Interestingly, these alterations were not observed in the specimens of normal tunica, albuginea in the control group. But the existence of minimal alterations, the regularity in the apparently normal contralateral tunica albuginea specimens in Peyronies disease implied that there was an active turnover in collagen production, and the possible factor causing collagen degeneration and so plaque formation was probably the microtraumatization of the tunica albuginea.

Ultrastructual changes of corpora cavernosa in vascular erectile dysfunction

Corpora cavernosa of 4 impotent patients with arterial pathology and 6 with venous insufficiency were studied by electron microscopy. The findings in all of the smooth muscle samples were the following: pronouned thickening of the basal lamina; marked reduction of contractile myofilaments and electron dense bodies; finger-like cytoplasmic projections; increase in mitochondria with swelling and aggregation; huge protrusions of nuclear membrane into the cytoplasm; increased proportion of interstitial matrix to smooth muscle cells. These were more marked in the dark than in the light cells, which was considered as the beginning of degeneration.Another finding was degenerative changes in the endothelial cell lining of the sinusoids, especially denudation, fragmentation and marked thickening of the basal lamina. Severity of the symptoms did not change in any of the patients with different pathologies. So, we can assume that the pathological alterations may be due to chronic penile vascular insufficiency or vice versa.

Electrocardiographic abnormalities in patients with organic erectile dysfunction: comparison with an age-matched control group

AimsOur purpose was to determine the incidence of electrocardiographic (ECG) abnormalities in patients with organic erectile dysfunction (ED) and to compare the results with an age-matched control (potent) group.MethodsA total of 218 men with ED of organic etiology formed our study group. A total of 210 age-matched men who had urologic disease other than ED served as control group. An experienced cardiologist who was blind to the primary diagnosis evaluated the ECGs in the entire group. The results were reported as either normal or abnormal according to the presence or absence of an abnormality suggestive for cardiovascular disease.ResultsThe mean age of the study and control groups was 58xa0years (range for the study group 28–82 years and for the control group 28–80xa0years). Abnormal ECG rates among patients with ED and control subjects were comparable. The incidences of ECG abnormalities in the study and control groups were 21.1% and 17.1%, respectively (Pxa0=xa00,298). No ECG abnormality was detected in males younger than 40 in either group.ConclusionMiddle-aged or older men with ED may carry potential risk for cardiovascular diseases in the absence of cardiovascular symptoms. However, patients with organic ED are not under increased risk for ECG abnormalities.

Comparison of nocturnal penile tumescence monitoring and cavernosal smooth muscle content in patients with erectile dysfunction

Purpose: Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction.Materials and methods: Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA.Results: We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p < 0.05). However we did not observe statistically significant difference with regard to second vs third group (p > 0.05).Conclusion: NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.

Penile Epithelioid Sarcoma

Epitheloid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.

Megacystis secondary to myenteric plexus pathology. Presentation of two cases.

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.

Evaluation and surgical treatment of patients with penile curvature

In patients with adult penile curvatures the aim of treatment is to have a penis straight enough and firm enough to allow satisfactory sexual function. Several operative approaches have been used to correct this condition. Herein, we describe our experience with the evaluation and surgical treatment of 37 patients with penile curvature. When we have decided on surgery, we either preferred to elongate the ventral corpora cavernosa by interposition of a piece of dura mater (2 patients) or in most cases (the remaining 35 patients) only excised wedges of tunica albuginea at the arcs of the maximum curvature located with artificial erection (Nesbits operation).In conclusion, our results showed that Nesbits operation is a versatile procedure that proved to be useful for correction of penile curvatures in patients with Peyronies disease. However, further studies and clinical trials are needed to determine if the dura mater is an alternative in the treatment of penile curvatures due to congenital aetiology.

Scrotal Calcinosis: A Case Report And Review Of Literature

Skrotal kalsinozis (SK) skrotum derisinde çok sayıda küçük kalsifik nodüllerle karakterli, nadir görülen iyi seyirli bir hastalıktır. Nodüller zaman içinde sayıca ve boyut olarak artış gösterir. Hastalar genellikle uzun seneler bu hastalıkla yaşarlar ve kozmetik kaygıları dışında doktora başvurmazlar. Lezyonların histopatolojik incelemesinde, dermisde karakteristik amorf homojen kalsiyum depolanmaları içeren globuler bazofilik nodüller ve bunları çevreleyen histiositik dev hücrelerin eşlik ettiği kronik granülomatöz inflamasyon izlenir. SK gelişimine ait birçok hipotez ortaya atılmıştır. Bunların en popüler olanları epitelyal kist zemininde gelişmiş distrofik kalsifikasyon teorisi ile idyopatik etyoloji teorisidir. Bu yayında, tesbit edildiği andan itibaren 3 ay gibi kısa bir sürede hızla büyüyen skrotal nodüllere sahip 51 yaşında bir SK hastası sunmaktayız. Skrotal eksizyon materyelinin histopatolojik incelenmesinde, tipik SK lezyonlarına eşlik eden 3 adet küçük epitelyal kist ile bir kenarında epitel komponenti içeren 1 adet kalsifik nodül izlenmiştir. Bulgularımız, kalsifik nodüllerin epidermal kistlerin distrofik kalsifikasyonu ile geliştiği tezini destekler nitelikte olup, histopatolojik tablonun lezyonun yaşına göre değiştiği anlaşılmaktadır. Nodüllerin zaman içinde sayısının artması altta yatan nüks eden bir patolojinin varlığını düşündürmektedir. Bulgularımız, bu hazırlayıcı faktörün epitelyal kistler olduğunu düşündürmüştür. SK’de farklı safhalardaki lezyonların birlikte bulunması, sıklıkla kronik dönemde eksize edilmeleri nedeniyle de lezyonlarda epitelyal komponent izlenememesi şaşırtıcı bir bulgu olmamalıdır.