Levent Emir

Acupuncture Versus Paroxetine for the Treatment of Premature Ejaculation: A Randomized, Placebo-Controlled Clinical Trial

BACKGROUND Acupuncture therapy has been used by many researchers in both male and female sexual dysfunction studies. OBJECTIVE To determine whether acupuncture is effective as a premature ejaculation (PE) treatment compared with paroxetine and placebo. DESIGN, SETTING, AND PARTICIPANTS The study was conducted with methodologic rigor based on Consolidated Standards of Reporting Trials (CONSORT) criteria. Ninety patients referred to the urology clinic at a tertiary training and research hospital with PE were included in this randomized controlled trial and randomly assigned into paroxetine, acupuncture, and placebo groups. Heterosexual, sexually active men aged between 28 and 50 yr were included. Men with other sexual disorders, including erectile dysfunction; with chronic psychiatric or systemic diseases; with alcohol or substance abuse; or who used any medications were excluded. INTERVENTION The medicated group received paroxetine 20 mg/d; the acupuncture or sham-acupuncture (placebo) groups were treated twice a week for 4 wk. MEASUREMENTS Intravaginal ejaculation latency times (IELTs) and the Premature Ejaculation Diagnostic Tool (PEDT) were used to assess PE. IELTs were calculated by using a partner-held stopwatch. Data were analyzed statistically. RESULTS AND LIMITATIONS Median PEDT scores of paroxetine, acupuncture, and placebo groups were 17.0, 16.0, and 15.5 before treatment, and 10.5, 11.0, and 16.0 after treatment, respectively (p=0.001, p=0.001, and p=0.314, respectively). Subscores after treatment were significantly lower than subscores before treatment in the paroxetine and acupuncture groups but remained the same in the placebo group. Significant differences were found between mean-rank IELTs of the paroxetine and placebo groups (p=0.001) and the acupuncture and placebo groups (p=0.001) after treatment. Increases of IELTs with paroxetine, acupuncture, and placebo acupuncture were 82.7, 65.7, and 33.1 s, respectively. Extent of ejaculation delay induced by paroxetine was significantly higher than that of acupuncture (p=0.001). The most important limitation of the study was the lack of follow-up. CONCLUSIONS Although less effective than daily paroxetine, acupuncture had a significant stronger ejaculation-delaying effect than placebo.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

Isolated renal and retroperitoneal hydatid cysts

Four patients (3 male, 1 female) with isolated renal and 1 female patient with isolated retroperitoneal cysts were reviewed. The mean age of the patients was 46 (25–64). The most common presenting symptom was pain. Two cases were discovered incidentally by the observance of renal calcification onabdominal x-ray. Indirect hemagglutination test was positive in all cases but eosinophilia was present only in 1 (20%) case. Nephrectomy was performed to 1 patient who presented with hydaturia and had a large communicating cyst involving most of the kidney. Total cystectomy was performed in other renal cysts. Total cystectomy with wide excision of the involved muscle was performed to the retroperitoneal hydatid cyst.Patients were followed by an average of 23.8 (9–50) months with indirect hemagglutination test and USG. No evidence for recurrence was found up to date.

A huge unusual mass on the penile skin: Acrochordon

Acrochordons are flesh-coloured pedunculated lesions which occur in areas of skin folds. Although they are common in other sites of the body, we report the first case of huge penile acrochordon in the literature. Clinical, pathological and surgical findings of this lesion were presented and discussed.

Single-institution Outcomes of Open Reconstruction Techniques for Management of Pediatric and Adolescent Post-traumatic Urethral Strictures

OBJECTIVES To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. METHODS A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. RESULTS The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. CONCLUSIONS The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

Onlay island flap urethroplasty: a comparative analysis of primary versus reoperative cases.

OBJECTIVES To compare the outcome of the onlay technique in cases with an untouched urethral plate (group 1) and patients who had undergone previous hypospadias repairs (group 2). METHODS The records of the 50 patients undergoing onlay island flap urethroplasty in the past 10 years were reviewed. The frequency of fistula formation in both groups was compared using the appropriate statistical methods. RESULTS Seventeen and 33 patients were enrolled into groups 1 and 2, respectively. No statistically significant difference in patient age was present between the two groups (P >0.05). Flap necrosis in 2 patients and skin necrosis in 1 patient were encountered in group 2, with the meatus located at the penoscrotal region. Ischemic skin changes occurred in one primary patient with a mid-penile meatus. Urethrocutaneous fistula occurred in 2 (11.7%) of 17 primary cases and in 14 (42.4%) of 33 cases with multiple previous operations (Pearson chi-square test, P <0.05). A fistula rate of 61.5% was recorded in group 2 when the urethral meatus was located at the penoscrotal region. After withdrawal of the cases with penoscrotal meatus, the incidence of urethrocutaneous fistula was 6.7% (1 of 15) and 30% (6 of 20) in groups 1 and 2, respectively. CONCLUSIONS Multiple previous operations affected the outcome of repair with the transverse onlay preputial flap, particularly in cases with a penoscrotal meatus. Repeat hypospadias repairs are more prone to complications.

A rare cause of cystic testicular mass in an infant--cystic dysplasia of the testis.

In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.

Our 21-Year Experience with the Thiersch-Duplay Technique following Surgical Correction of Penoscrotal Transposition

Objectives: To assess surgical techniques applied after surgical correction of penoscrotal transposition and their complications. Methods: The medical records of 64 patients with a mean age of 4.1 years (range 1–24) who underwent surgical correction for penoscrotal transposition and subsequent Thiersch-Duplay urethroplasty in the last 21 years were evaluated retrospectively. Results: All cases underwent Thiersch-Duplay urethroplasty following reconstruction of penoscrotal transposition after a minimum interval of 6 months. Following Thiersch urethroplasty, 41 (64%) cases with successful outcomes had glandular meatuses. Of the remaining 23 (36%) patients 15, 7 and 1 patients underwent second operations for urethrocutaneous fistulas, meatal regressions and urethral diverticulum, respectively. Eleven of 15 patients underwent primary fistula repair and 4 patients, turnover fistula repair. These patients had glandular meatuses following fistula repair. Seven cases with meatal regression and breakdown of the neourethra were reoperated on by using double-face urethroplasty, onlay island flap urethroplasty and free-tube urethroplasty techniques. Finally, all patients had glandular meatuses. One patient with urethral diverticulum underwent successful diverticulum excision and meatoplasty. Conclusions: Thierch uretroplasty is the most commonly performed technique after surgical correction of penoscrotal transposition; however, additional procedures are needed for the management of its complications.

A Novel Solution for the Short Neourethra in Mitchell Epispadias Repair

Epispadias is a rare congenital abnormality of the genitalia that is manifested by a dorsal urethral cleft. Epispadias surgery has undergone many modifications since the initial report of Cantwell. 1 Mitchell recently developed a new technique involving complete disassembly of the corporeal glandular bodies and urethral plate.2 This approach is a significant contribution to epispadias surgery. Complete separation of the corpora cavernosa provides an effective ventral corporeal counter-rotation to correct epispadiac dorsal chordee. The technique also restores an anatomically normal glans. The only disadvantage of this approach is the occasionally encountered short urethra during the repair. We describe a new method to overcome this problem during Mitchell epispadias repair.

Chemical castration with intratesticular injection of 20% hypertonic saline: a minimally invasive method.

OBJECTIVES Our aim was to ablate testicular tissue by hypertonic saline solution in a rat model, thereby to discover a minimally invasive alternative method to medical and surgical castration in patients with metastatic prostate carcinoma. METHODS A total of 40 male Wistar rats were divided into orchiectomy (n = 20) and experimental groups. In the experimental group, 20% (n = 20) hypertonic saline solution was injected into the rat testes. Blood was taken prior to, 1 day, and 30 days after the intervention for testosterone determination. All testicles were surgically removed for pathologic examination. RESULTS Skin infection, necrosis, and testicular abscess were not detected in any rat. Pathologic examination revealed necrosis in almost all areas of the testicle. The comparison of 0, day 1, and day 30 measurements of total testosterone did not reveal a statistically significant difference between the control and hypertonic saline groups at each of the three time points (Mann-Whitney U-test, P > 0.05). CONCLUSIONS Intratesticular hypertonic saline injection seems to be an alternative method in the future to its rivals such as orchiectomy and medical castration. This new approach offers a minimally invasive and less expensive method aside from preserving body image in metastatic prostatic carcinoma. However, our conclusions should be supported with more experimental studies before a clinical study is taken into account.