Mehmet Gulum

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.

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.

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.

Diffusion-Weighted MRI of the Testes in Patients With Varicocele: A Preliminary Study

OBJECTIVE This preliminary study aimed to evaluate changes in apparent diffusion coefficient (ADC) values of the testes in patients presenting with varicocele. SUBJECTS AND METHODS This cross-sectional study included 25 consecutively recruited patients with varicocele and 25 healthy control volunteers. The ADC values were measured in all participants. Kolmogorov-Smirnov tests were used to test the normality of the data distributions, and the data were expressed as arithmetic means and SDs. A one-way analysis of variance with a post hoc Bonferroni test was used to analyze normally distributed continuous data. Independent sample Student t tests were used to compare continuous variables between two groups. Furthermore, a Pearson correlation coefficient analysis was used to examine the association of venous diameters with mean ADC values in patients with varicocele. A two-sided p value < 0.05 was considered statistically significant. Sensitivities, specificities, and areas under the curve were calculated for the ADC values. RESULTS The ADC values associated with the ipsilateral testicular parenchyma of patients with varicocele were found to be lower than those of healthy volunteers. Moreover, the ADC values of the contralateral testicular parenchyma in patients with varicocele were also lower than those of healthy volunteers. The sensitivity and specificity of ADC values were 90% and 96%, respectively, for patients with varicocele and 89.5% and 96% for healthy volunteers. The mean ADC values were significantly negatively correlated with venous diameter. CONCLUSION The measurement of testicular ADC values may be used as a diagnostic indicator in the detection of testicular fibrosis.

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.

Minimal Transurethral Prostatectomy plus Bladder Neck Incision versus Standard Transurethral Prostatectomy in Patients with Benign Prostatic Hyperplasia: A Randomised Prospective Study

Objective: To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). Patients and Methods: Forty patients with prostates of ≤25 ml were randomized to two equal groups (20 cases in each). In group I minimal transurethral resection of the prostate followed by bladder neck incision at the 6 o’clock position and in group II standard TURP were performed. Patients were evaluated in terms of the change in symptom severity, maximal flow rate and sexual function in addition to operating time, length of hospital stay, problems of catheter positioning at the end of the operation and the rate of bladder neck contracture using χ2 and independent t tests. Results: Age, prostate volume postoperative follow-up time, improvement in international prostate symptom score and maximal flow rate, length of hospital stay and erectile dysfunction rates were not statistically different between the 2 groups. Operation time was shorter in group I (p = 0.001). Although the urethral catheter was easily positioned at the end of the operation in group I, it was not possible in group II for 4 patients (p = 0.053). Postoperative retrograde ejaculation for groups I and II were determined in 7 and 16 patients, respectively (p = 0.005). Bladder neck contracture was not found in group I, while it was seen in 2 patients in group II (p = 0.487). Conclusion: The combination of minimal transurethral resection and bladder neck incision in patients with small prostates appears to provide a satisfactory clinical outcome, comparable with standard TURP, while preventing the difficulty of urethral catheter positioning at the end of the operation, decreasing bladder neck contracture and lowering the incidence of retrograde ejaculation.

Evaluation of Sexual Function in Men with Orchialgia

This study examined the effect of chronic scrotal pain on sexual function using the International Index of Erectile Function (IIEF). We enrolled 50 patients with symptoms consistent with orchialgia and 50 control subjects without orchialgia, who were healthy, sexually active, married, and age-matched. Both groups were evaluated using the IIEF questions for sexual function, and quality of life was investigated using the abbreviated version of the World Health Organization Quality of Life Questionnaire. A significant difference was found in the values of orgasmic function, intercourse satisfaction, sexual desire, overall sexual satisfaction, and total IIEF scores between the patient and control groups; however, there were no significant group differences in the IIEF scores related to erectile function. In the patient group, 39 of 50 subjects reported decreased sexual desire and satisfaction due to a decrease in frequency of sexual activities. Thus, investigation of sexual function was essential for these patients in order to determine the adequate management and treatment of chronic orchialgia.

A case of an ectopic ureter with vaginal insertion diagnosed in adulthood

Ectopic ureter which is one of the causes of urinary incontinence in adults is a rarely seen entity. In this case, diagnosis and treatment of urinary incontinence in a female patient thought to originate from an ectopic ureter will be evaluated. On magnetic resonance (MR) urograms double collecting system in both kidneys and also grade 3 hydroureteronephrosis in the collecting system which drained the upper pole of the right kidney were seen. The ureter draining the upper pole of the right kidney was seen to open into a 24 mm-wide cystic pouch inside the right lateral wall of the vaginal cuff. During vaginal examination an orifice of 3 mm was observed on the right wall of the vagina. Right ureteroneocystostomy was performed. Ureters with ectopic orifices are very rarely seen causes of urinary incontinence. To establish the diagnosis, this pathology must be recognized, should be kept in mind, and appropriate diagnostic methods must be used.

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.

Sperm DNA damage and seminal oxidative status after shock-wave lithotripsy for distal ureteral stones.

OBJECTIVE To investigate the relationship between level of sperm DNA damage, seminal oxidative status, and shock-wave lithotripsy (SWL) for distal ureteral stones. DESIGN Prospective study with control. SETTING Academic research institute. PATIENT(S) Men who had undergone SWL for distal and upper ureter stones. INTERVENTION(S) Level of sperm DNA damage and seminal oxidative status assessed through the examination of semen on the day before and 3 days, and 3 months after SWL. MAIN OUTCOME MEASURE(S) DNA damage score and oxidative stress in semen parameters. RESULT(S) Sperm DNA damage score and semen total oxidant status (TOS) levels increased, but semen total antioxidant status (TAS) levels, sperm concentration, and motility decreased immediately after SWL. However, there were no statistically significant correlations between the DNA damage scores and the increased TAS and TOS levels in the study group. All of the changes returned completely to initial level during three months after SWL. CONCLUSION(S) SWL may affect fertility in men. Therefore, we suggest other treatment modalities, such as ureteroscopy, for young men with distal ureteral stones to prevent the development of male infertility.