Mehmet Karabakan

The prevalence of premature ejaculation in young Turkish men

This study was conducted to investigate the prevalence of premature ejaculation (PE) in young Turkish men and to evaluate PE in a population having good physical and mental health. A total of 1230 healthy university graduates aged between 24 and 30 attending the police academy having no physical or mental problems were included in the study. To identify the presence of PE, the participants were asked to complete the premature ejaculation diagnostic tool (PEDT). The mean ages in the PE and non‐PE group were 27.3 and 26.7 respectively. There was no statistically significant difference between the two groups concerning age, body mass index (BMI), smoking status and alcohol consumption (P > 0.05). The PE prevalence was found to be 9.2%. The mean PEDT score was calculated as 6.3. Of the participants, 92 scored 11 and higher (9.2%), 66 scored 9 and 10 (6.6%), and the remaining 842 obtained a score equal to or lower than 8 (84.2%). The lower prevalence of PE in young Turkish men compared to the results of studies in the literature can be attributed to the physical and mental well‐being of the participants. This study showed that the prevalence of PE in young men with good physical and mental health is lower than that found in the literature.

Association between serum fetuin‐A level and erectile function

Recent studies have shown that ED is an early symptom of atherosclerosis. Fetuin‐A, a glycoprotein secreted by the liver, kidneys and choroid plexus, has been linked to systemic fibrosis and calcification in human and rat studies. Deficiency of this compound may play a role in atherosclerosis and cardiovascular disease progression. The aim of the study was to examine whether serum fetuin‐A level is related to erectile function or severity of ED. Sixty ED patients without cardiovascular disease were assigned to one of the three groups (mild, moderate or severe ED) depending on ED severity. Twenty healthy volunteers were included as the control group. The International Index of Erectile Function‐5 questionnaire was used to measure erection quality in all four groups. Mean age, body mass index, total testosterone, low‐ and high‐density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the three erectile dysfunction and control groups (P > 0.05). The group with severe ED had a significantly lower mean fetuin‐A level than the mild ED and control groups. For both mild and moderate ED groups, the mean serum fetuin‐A level was significantly lower in comparison with the control group (P < 0.001). Serum fetuin‐A level may be used as a supplemental biochemical parameter in preliminary evaluation of ED.

Association between serum folic acid level and erectile dysfunction

This study measured the serum folic acid (FA) level in patients with erectile dysfunction (ED) and evaluated the possible association between the serum FA level and erectile function. The study divided 120 patients with ED into 3 groups of 40 patients each: those with severe, moderate and mild ED. Forty healthy men served as controls. Fasting serum samples were obtained, and the total testosterone, cholesterol and FA levels were measured using chemiluminescent immunoassays. There were no significant differences in the mean age, mean body mass index or mean serum total testosterone and cholesterol levels among the three ED groups and controls (P > 0.05). The mean serum FA concentrations were 7.2 ± 3.7, 7.1 ± 3.2, 10.2 ± 4.6 and 10.7 ± 4.6 ng ml−1 in the severe, moderate and mild ED and control groups respectively. The mean serum FA concentration was significantly higher in the control group than in the severe and moderate ED groups (both P < 0.001), but not the mild ED group (P = 0.95). Considering the significant differences in the serum FA levels between the control and ED groups, serum FA deficiency might reflect the severity of ED.

Flurbiprofen alone and in combination with alfuzosin for the management of lower urinary tract symptoms.

Introduction We aimed to investigate the effectiveness and safety of flurbiprofen, a non-steroidal anti-inflammatory drug with dual cyclooxygenase inhibition, and α-blocker alfuzosin, both alone and in combination with each other for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO). Material and methods Ninety patients complaining of moderate-to-severe LUTS/BPO were randomly assigned into 3 groups (30 patients each) to receive alfuzosin XL 10 mg, or flurbiprofen SR 200 mg, or combination of alfuzosin XL 10 mg and flurbiprofen SR 200 mg, once daily for 4 weeks. Patients were evaluated using the international prostate symptom score (IPSS) (total and IPSSstorage, IPSSempty subscores), uroflow-metry (maximum (Qmax) and average (Qave) flow rates) and postvoid residual urine (PVR) both at baseline and following the drug therapy course. Results There was no difference among the 3 groups regarding age and baseline values of prostate volume, IPSS, IPSSstorage, IPSSempty, Qmax, Qave and PVR (P >0.05). IPSS, IPSSstorage, IPSSempty, and PVR decreased significantly in all the 3 groups after drug therapies (P <0.01). However, Qmax and Qave significantly improved only in the combination group (P <0.01). Conclusions Addition of flurbiprofen increased the therapeutic effectiveness of alfuzosin by further improving symptoms in patients with LUTS/BPO. Combination therapy also improved urine flow compared to baseline. Monotherapy with flurbiprofen was not superior to alfuzosin.

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

OBJECTIVE The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. MATERIAL AND METHODS Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months). RESULTS At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. CONCLUSION Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease

We investigated the effect of spinal anesthesia combined with obturator nerve block (ONB) during the transurethral resection of lateral bladder wall tumors (TUR‐BT) on the presence of detrusor muscle tissue in tumor specimens and on tumor recurrence. TUR‐BT was performed on 96 patients with a lateral bladder wall tumor under spinal anesthesia in our clinic between January 2011 and December 2015. The patients were divided into two groups: 49 patients only received spinal anesthesia and 47 patients received spinal anesthesia combined with ONB. The groups were retrospectively compared in terms of adductor muscle contraction, bladder perforation, complete tumor resection, presence of muscle tissue in the pathology material, and recurrence rate during follow‐up. The obturator reflex was significantly observed in the non‐ONB group (p < 0.05). In the ONB group, the percentages of complete resection and detrusor muscle tissue were significantly higher (p = 0.003 and p = 0.001, respectively). The postoperative recurrence rate was found to be significantly higher in the non‐ONB group than in the ONB group (p = 0.025). Spinal anesthesia combined with ONB during TUR‐BT prevent obturator reflex and facilitate complete resection including detrusor muscle tissue, independent from the size or number of tumors, thus reducing the recurrence of the disease.

Association between pre–biopsy white blood cell count and prostate biopsy – related sepsis

Introduction Despite all preventive measures and improved biopsy techniques, serious, life–threatening complications of prostate biopsy, including sepsis, still exist. In the present study, in order to identify the risk factors that may be associated with sepsis development after prostate–biopsy, we aimed to analyze retrospectively the data of our patients who underwent transrectal ultrasound–guided prostate biopsy. Material and methods We retrospectively reviewed the data of 889 patients who underwent prostate biopsy at our clinic. We compared pre–biopsy parameters (age, prostate volume, white blood cell (WBC) count, fasting blood glucose, free and total prostate specific antigen levels) between patients who developed sepsis and those who were sepsis–free following prostate biopsy. Results 28 patients (3.1%) developed sepsis. Among the risk factors evaluated, only pre–biopsy WBC count was found to be a significant risk factor for biopsy–related sepsis. A 5.1 fold increase was detected in the risk for sepsis development, when the cut–off value of WBC was accepted as 11.165/μL, OR: 5.1 (95% CI: 2.3–11.5). The post–biopsy sepsis development rate in patients with pre–biopsy WBC count greater and less than 11.165/μL was 13.7% (n = 10) and 3% (n = 18) respectively. Conclusions Patients with a pre–biopsy WBC count greater than 11.165/μL should be informed of the increased risk of developing post–biopsy sepsis.

Is there any relationship between serum levels of total bilirubin and the severity of erectile dysfunction

Objective: Recent studies have shown that atherosclerosis is associated with erectile dysfunction and the serum bilirubin level. In this study, the serum total bilirubin levels of patients with erectile dysfunction were measured to investigate the relationship between the levels of erectile dysfunction and total bilirubin. Methods: A total of 94 patients with erectile dysfunction were divided into three groups; severe erectile dysfunction (33 patients), moderate erectile dysfunction (31 patients), and mild erectile dysfunction (30 patients). In addition, a control group was formed with 31 healthy men. The International Index of Erectile Function-5 Questionnaire was used to measure the quality of erection in all the groups. The body mass index was calculated for all the participants. The serum glucose, low-density lipoprotein and high-density lipoprotein, cholesterol, triglyceride, total bilirubin, and total testosterone levels were also determined. Results: No statistically significant difference was observed between the groups in terms of the mean age, hypertension, smoking status, alcohol use, cardiovascular diseases, hepatobiliary disease, diabetes mellitus, and levels of total testosterone, low-density lipoprotein–cholesterol, and triglyceride. However, high-density lipoprotein, body mass index, and total bilirubin were significantly lower compared to the control group (p < 0.001). The serum total bilirubin level was found to be 0.41 ± 0.21 ng/dL in the severe erectile dysfunction, 0.43 ± 0.19 ng/dL in the moderate erectile dysfunction, and 0.48 ± 0.11 ng/dL in the mild erectile dysfunction groups (p < 0.001). Conclusion: Considering the significant differences between the erectile dysfunction and control groups in terms of serum total bilirubin levels, a low level of bilirubin may have a role in the etiology of erectile dysfunction.

Does extracorporeal shockwave lithotripsy therapy affect thiol-disulfide homeostasis?

Objective: Extracorporeal Shockwave Lithotripsy (ESWL) is a non-invasive method that is effective at crushing stones in the upper urinary tract. Disturbance of the thiol/disulfide homeostasis, in favor of the disulfide, has been shown to be involved in the disease pathogenesis. Methods: A total of 36 individuals that underwent ESWL had blood samples collected before ESWL (0hrs), 6hrs, and one week after the ESWL. Sera native and total as wells as disulfide amount was measured using an automated method sodium borohydrate (NaBH4) reduction. In addition, Ischemia Modified Albumin (IMA) levels were measured using colorimetric assay method. Results: Native thiol level was reduced at the 6th hour following ESWL compared to baseline. While the ratios of disulfide level, Disulfide/Total Thiol (DTT), Disulfide/Native Thiol (DNT) and IMA level were increased at the 6th hour following ESWL compared to baseline, they were found to be similar with their baseline values at the end of 1st week. Total thiol and native /total thiol did not show any significant change. Conclusions: ESWL treatment disrupts thiol/disulfide homeostasis and the structure of albumin at the acute term. Therefore, it increases protein oxidation and leads to increased oxidative stress. However, this state is transient and returns to normal within the proceeding days.

Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy

PURPOSE To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy (NSRP) due to localized prostate cancer (PCa). MATERIALS AND METHODS Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. RESULTS Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6th month follow-up (p > 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). CONCLUSIONS The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.