Kerem Taken

Erectile dysfunction is a marker for obstructive sleep apnea

Abstract Purpose: To investigate the prevalence of erectile dysfunction (ED) in patients with obstructive sleep apnea (OSA) with and without any other comorbidities. Methods: The patient group was newly diagnosed as having OSA (apnea–hypopnea index [AHI] > 5/h) using a polysomnographic examination. A group of subjects with simple snoring were included into the control group. Clinically relevant comorbidities were systematically assessed in face-to-face interviews. All patients were asked to complete the 15-item International Index of Erectile Function (IIEF-15) questionnaire for the evaluation of ED. The patients with OSA and ED were evaluated according to these comorbidities. Results: Of the 94 patients, 39 patients were excluded because of severe diseases. OSA was observed in 38 (69.1%) of the 55 patients. ED was seen in 24 (63.2%) patients with OSA, and in 8 (47.1%) patients without OSA (p > 0.05). There were no statistical differences between the groups’ ages, IIEF scores, and body mass index (BMI) scores. There were statistically significant differences between the groups’ AHI scores (p < 0.05). There was a significant correlation between the groups’ AHI scores, BMI, and age (p < 0.05). There was no statistically significant difference in patients with OSA, with and without comorbidity in terms of ED. Conclusion: The rate of ED was higher in patients with OSA who had no other comorbidities. Therefore, ED can be a sensitive marker of OSA.

Peripheral mononuclear leukocyte DNA damage, plasma prolidase activity, and oxidative status in patients with benign prostatic hyperplasia

Abstract Objectives Prolidase plays a major role in collagen turnover, matrix remodeling, and cell growth. Benign prostatic hyperplasia (BPH) may be associated with an increased extracellular matrix deposition. Therefore, the present study was designed to investigate the plasma prolidase activity, oxidative status, and peripheral mononuclear leukocyte DNA damage in patients with BPH. Patients and methods Twenty-six male patients with BPH and 24 healthy male subjects were included in this study. Blood samples were collected from antecubital vein after an overnight fasting period, and the plasma was separated. Plasma prolidase activity, total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) were determined. The peripheral lymphocyte oxidative DNA damage was determined using an alkaline single cell gel electrophoresis assay (comet assay). Results The plasma prolidase activity, TOS levels, OSI values, and peripheral mononuclear leukocyte DNA damage were significantly higher (P < 0.001), while the TAC levels were significantly lower (P < 0.001) in patients with BPH than controls. In BPH patients, the prolidase activity was significantly associated with TAC levels (r = −0.366, P < 0.05), TOS levels (r = 0.573, P < 0.001), and OSI (r = 0.618, P < 0.001) and peripheral mononuclear leukocyte DNA damage (r = 0.461, P < 0.001). Conclusions Our results showed that BPH might be associated with an increased oxidative stress, and also an increased plasma prolidase activity. Increased prolidase activity might play an important role in the etiopathogenesis and/or progression of BPH.

Preoperative levels of matrix metalloproteinase-7 and -9 and tissue inhibitor of matrix metalloproteinase-1 relation to pathologic parameters in bladder carcinoma patients.

Our aim was to test the hypothesis that preoperative serum levels of matrix metalloproteinase-7 (MMP-7) and -9 (MMP-9) and tissue inhibitor of matrix metalloproteinase (TIMP-1) levels correlate with pathological features. Serum levels of MMP-7, and MMP-9 and TIMP-1 were determined in 90 bladder cancer patients and 40 healthy controls using an enzyme linked immunosorbent assay. Preoperative serum MMP-7 and MMP-9 levels were significantly higher in cancer patients than control groups (p<0.001). In contast, serum TIMP-1 levels were lower (p<0.001). Alteration in MMP-7, and MMP-9, and TIMP-1 production may contribute to tumor angiogenesis and be associated with clinic-pathological features.

Fournier's gangrene: Causes, presentation and survival of sixty-five patients.

Objective: To report our experience with Fournier’s Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results: Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions: Fournier’s gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity.

Isolated renal pelvis rupture secondary to blunt trauma: Case report

Highlights • A case, with isolated renal pelvis rupture due to blunt abdominal trauma.• Clear urine output from the urinary catheter was seen in patient.• Diagnosed a large rupture of renal pelvis by abdominal contrast enhanced CT.• Isolated rupture of the renal pelvis causes delays in the diagnosis of the rupture.• Only a few isolated cases of pelvis rupture with resultant extravasation have been described previously in literature.• Surgical intervention should be warranted in emergency cases.

Levels of serum trace elements in patients with Peyronie

Abstract Aim: The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie’s disease (PD) in genetically predisposed individuals. In this study, we aimed to determine the relationship of some trace element and heavy metals with PD. Material and methods: Thirty Peyronie patients and 26 healthy volunteers were included in the study. In individuals in both groups, levels of serum trace elements (Manganese [Mn], Cu, Cobalt (Co), zinc [Zn], Cd, and iron [Fe]) were determined separately by Atomic Absorption Spectrophotometer method in Yüzüncü Yıl University Central Research Laboratory. Results: Mn, Cu, Zn, and Fe levels in Peyronie patients were statistically significantly lower when compared to the healthy control group (p < .05). Cd and Co levels were similar for both groups but not statistically significant (p > .05). Conclusions: The changes in trace element levels are related to the etiopathogenesis of PD. We think that our study is the first from this aspect.

Reliability of testicular stiffness quantification using shear wave elastography in predicting male fertility: a preliminary prospective study

AIMS To evaluate the reliability of testicular stiffness quantification using shear wave elastography in predicting the fertility potential of males and for the pre-diagnosis of disorders based upon sperm quantification. MATERIAL AND METHODS One hundred males between the ages of 19-49 years (mean age of 28.77±6.11), ninety of whom with complaints of infertility, were enrolled in this prospective study. Scrotal grey-scale, Doppler ultrasound (US), and mean testicular shear wave velocity quantifications (SWVQs) were performed. The volumes of testes, as well as the grade of varicocele if present, were recorded. The mean shear wave velocity values (SWVVs) of each testis and a mean testicular SWVV for each patient were calculated. The semen-analyses of patients were consecutively performed. RESULTS There were significant negative correlations between the mean testicular SWVVs of patients and their sperm counts or the testis volumes (r=-0.399, r=-0.565; p<0.01, respectively). A positive correlation was found between testicular volumes and sperm counts (r=0.491, p<0.01). The cut-off values regarding mean testicular SWVV to distinguish normal sperm count from azoospermia and oligozoospermia were 1.465 m/s (75.0% sensitivity and 75.0% specificity) and 1.328 m/s (64.3% sensitivity and 68.2% specificity), respectively, and the value to distinguish oligozoospermia from azoospermia was 1.528 m/s (66.7% sensitivity, 60.7% specificity). CONCLUSION The mean testicular SWVQ using the ARFI shear wave technique was a reliable, non-invasive and acceptably stable method for predicting male infertility, especially related to sperm count issues.

Our initial experiences in Micro Percutaneous Nephrolithotomy

Böbrek taşı tedavisinde gelişen komplikasyon oranlarını azaltmak için klasik perkütan nefrolitotomi (PNL) prosederünü takiben akses traktı daha küçük olan mini ve ultra-miniPNL yöntemleri geliştirilmiştir (1,2). Mikro-PNL ise daha az invaziv, tek basamakta akses yapılan ve akses traktı daha küçük olan bir işlemdir (3,4). Mikro-PNL’nin en önemli avantajı kanamanın az olması ve komşu organ yaralanması riskinin az olmasıdır (5,6). Mikroperkütan nefrolitotomi, küçük ve orta büyüklükteki seçilmiş olgulara önerilmektedir (7). ÖZET

Oxidative DNA Damage to Sperm Cells and Peripheral Blood Leukocytes in Infertile Men

Background Oxidative DNA damage is associated with male infertility. The aim of this study was to evaluate the oxidative DNA damage of sperm cells and blood leukocytes and to determine the levels of MDA and NO levels in seminal and blood plasma of idiopathic infertile men. Material/Methods The study enrolled 52 patients, including 30 infertile and 22 fertile men. MDA, NO, and 8-OHdG/106dG were estimated using spectrophotometry and high-pressure liquid chromatography (HPLC)-based methods in seminal and blood plasma. The association with the sperm parameters was assessed, particularly sperm counts and motility. Results The mean sperm concentration and sperm motility of the fertile men were significantly higher than that of the infertile men. The mean MDA and NO concentration in the seminal and blood samples of the infertile men were higher than that of fertile men. Also, the mean numbers of sperm cells and leukocytes 8-OHdG/106dG of the infertile men were significantly higher than that of fertile men (p=0.04 and p<0.001, respectively). Sperm motility and sperm count were negatively correlated with leukocyte and sperm cell 8-OHdG/106dG ratio. However, progressive motility was significantly negatively correlated with sperm cell and leukocyte 8-OHdG/106dG ratio (R=−0.357, p=0.026; R=−0.388, p=0.024, respectively). Conclusions Oxidative stress is an important factor in male infertility. Therefore, biochemical detection of 8-OHdG/106dG in sperm cells and blood leukocytes may be an additional tool in the diagnosis of male infertility.

Prevalence of Ureaplasma and Mycoplasma in Infertile Men in Van Region and Effects to Semen Parameters

Aim: The purpose of this study was to assess the prevalence of Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) in semen cultures of cases with primary infertility in the Van Province, and also to determine the effect of therapy on sperm parameters. Material and Method: The study included 106 individuals divided into three groups: The infertile group (41 cases), the group with lower urinary tract symptoms (33 cases), and the control group (32 cases). The patients in the infertile group had no history of varicocele, testicular torsion, hydrocele, undescended testis, and hormonal disorders. The control group included cases without infertility and lower urinary tract symptoms. The parameters of culture-positive cases in the infertile group were determined before and after therapy. The identification of Mycoplasma species was made using the Biomerieux® Mycoplasma IST 2 (RCS LyonFrance) kit. The sperm count was carried out with the Makler counting chamber (Self Medical Industries, Haifa, Israel). Results: In the infertile group, UU was isolated from 17 and MH was isolated from 3 cases. In the group with lower urinary tract symptoms, UU was isolated from 15 (45.5%) and MH was isolated from 6 (18.8%) cases. In the control group, UU was isolated from 6 (18.8%) cases, but MH was isolated from none of the cases. In the infertile group, the sperm counts in 3 culture-positive cases (15%) and in 10 culture-negative cases (50%) were <15 million each (p<0.025). Prior to therapy, the sperm motility in the culture-positive 14 cases (70%) was lower than 40%, and after therapy, 5 cases (25%) demonstrated a sperm motility of <40%. With therapy, a significant increase in sperm motility was obtained. After therapy of the 20 culture-positive cases (49%), the wives of 4 (20%) patients became pregnant (p<0.025). Discussion: Antibiotherapy in culturepositive cases with undetermined cause of infertility contributes to therapy by positively affecting sperm motility.